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Surgical Endoscopy

, Volume 4, Issue 2, pp 97–99 | Cite as

Canine colonic anastomoses reinforced with dye-enhanced fibrinogen and a diode laser

  • Steven K. Libutti
  • Mehmet C. Oz
  • Kenneth A. Forde
  • Joseph S. Auteri
  • Jeffrey P. Johnson
  • Lawrence S. Bass
  • Michael R. Treat
Original Articles

Summary

Leakage from colonic anastomoses is a common cause of morbidity in patients recovering from bowel surgery. We evaluated a technique of laser-fibrinogen reinforcement to strengthen colonic anastomoses in a canine model. After creation of eight single-layer interrupted suture anastomoses in six dogs, indocyanine green-dye-enhanced fibrinogen was topically applied to the serosal surface and exposed to 808 mm diode laser energy. Immediately following colonic anastomosis, the mean leakage pressure was 137±22 mm Hg in the group (n=8) using sutures alone and 326±67 mm Hg (P<0.001) in the group (n=8) after the sutured anastomosis was reinforced with lasered-fibrinogen. On histological examination, no evidence of thermal injury to the tissue edges was noted and a layer of fibrinogen bridged the anastomotic gap. Laser dye-enhanced fibrinogen reinforcement significantly enhances the strength of sutured colonic anastomoses without causing appreciable thermal injury to the host tissues.

Key words

Colonic anastomosis Fibrinogen Indocyanine green dye 808 nm diode lasers Laser welding 

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References

  1. 1.
    Brennan SS, Pickford IR, Evans M, Pollack AV (1982) Staples or sutures for colonic anastomoses — a controlled clinical trial. Br J Surg 69: 722–724Google Scholar
  2. 2.
    Chartrand C, Dumont L, Stanley P (1989) Value of fibrin sealant in heart transplantation. Transplant Proc 21: 3347–3348Google Scholar
  3. 3.
    Gestring GF, Lerner R (1983) Autologous fibrinogen for tissue adhesion, hemostasis, and embolization. Vasc Surg 17: 294–304Google Scholar
  4. 4.
    Giardino R, Cola B, Franchini A, Brulatti M (1984) Use of fibrin glue in abdominal surgery (abstract). Dig Surg 1: 128Google Scholar
  5. 5.
    Goligher JC, Lee PW, Simpkins KC, Lintott DJ (1977) A controlled comparison of one- and two-layer techniques of suture for high and low colorectal anastomoses. Br J Surg 64: 609–614Google Scholar
  6. 6.
    Hjortrup A, Nordkild P, Kjaergaard J, Sjontoft E, Olesen HP (1986) Fibrin adhesive vs sutured anastomosis: a comparative intraindividual study in the small intestine of pigs. Br J Surg 73: 760–762Google Scholar
  7. 7.
    Hjortrup A, Nordkild P, Christensen T, Sjontoft E, Kjaergaari J (1989) Rectal anastomosis with application of luminal fibrin adhesive in the rectum of dogs: an experimental study. Dis Colon Rectum 32: 422–425Google Scholar
  8. 8.
    Hoeir-Madsen K, Lindenberg HJ (1975) Anastomotic leakage following resection for cancer of the colon and rectum. Acta Chir Scand 141: 304–309Google Scholar
  9. 9.
    Irvin TT, Goligher JC (1973) Aetiology of disruption of intestinal anastomoses. Br J Surg 60: 461–464Google Scholar
  10. 10.
    Libutti SK, Oz MC, Chuck RS, Treat MR, Nowygrod R (1990) Dye enhanced tissue welding using fibrinogen and continuous wave argon lasers. Vasc Surg (in press)Google Scholar
  11. 11.
    Nordkild P, Hjortrup A, Kjaergaard J (1986) Tissue adhesives and intestinal anastomosis. Ann Chir Gynaecol 75: 205–208Google Scholar
  12. 12.
    Oka H, Harrison CH, Burhenne HJ (1982) Effects of biological glue on the leakage rate of experimental rectal anastomoses. Am J Surg 143: 561–564Google Scholar
  13. 13.
    Oz MC, Johnson JP, Parangi S, Chuck RS, Marboe CS, Bass LS, Nowygrod R, Treat MR (1990) Tissue soldering using indocyanine green dye enhanced fibrinogen with the near infrared diode laser. J Vasc Surg 11: 718–725Google Scholar
  14. 14.
    Sauer JS, Hinshaw RJ, McGuire KP (1989) The first sutureless, laser-welded, end-to-end bowel anastomosis. Laser Surg Med 9: 70–73Google Scholar
  15. 15.
    Schrock TR, Deveney CW, Dunphy JE (1976) Factors contributing to leakage of colonic anastomoses. Ann Surg 131: 47–53Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • Steven K. Libutti
    • 1
  • Mehmet C. Oz
    • 1
  • Kenneth A. Forde
    • 1
  • Joseph S. Auteri
    • 1
  • Jeffrey P. Johnson
    • 1
  • Lawrence S. Bass
    • 1
  • Michael R. Treat
    • 1
  1. 1.Department of SurgeryThe Columbia University College of Physicians & SurgeonsNew YorkUSA

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