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Studies in the healing of intestinal anastomoses

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Abstract

We have assessed the security of anastomoses made by a variety of techniques, and under various circumstances. (a) In small bowel, inverting and everting silk anastomoses and stapled anastomoses give equivalent results. (b) With everting closures and anastomoses, healing is from the cut end, and not at the suture line. (c) Foreign material around an anastomosis produces leaks with any type anastomosis. (d) In the colon, inverting manual anastomoses and stapled anastomoses are equivalent, and superior to one-layer manual everted anastomoses. (e) Induction of early intestinal action by Prostigmin® and castor oil has no adverse effect on inverted, or stapled anastomoses, at any level of bowel, but increases incidence of anastomotic leaks in silk everting anastomoses of colon. (f) Stapled anastomoses made in presence of 24-hour perforative peritonitis, 48-hour devascularized bowel, and 48-hour intestinal obstruction are as secure as inverting anastomoses.

Résumé

Nous avons étudié la sécurité d'anastomoses digestives réalisées avec des techniques variées et dans diverses circonstances: (1) pour le grÊle, les anastomoses à la soie, inversantes et éversantes, et les anastomoses faites avec un appareil à suture automatique, donnent des résultats équivalents. (2) Pour les anastomoses et sutures éversantes, la cicatrisation se fait au niveau de la tranche de section et non pas au niveau de la ligne de suture. (3) La présence de matériel étranger au voisinage des anastomoses, quel qu'en soit le type, favorise les lachages. (4) Pour le cÔlon, les anastomoses inversantes faites à la main et les anastomoses avec appareil à suture automatique sont équivalentes et sont meilleures que les anastomoses éversantes faites à la main en un plan. (5) L'administration précoce de prostigmine ou d'huile de ricin pour stimuler le péristaltisme intestinal n'a aucun effet délétère sur les anastomoses inversantes ou sur les anastomoses faites avec un appareil à suture automatique, quel que soit le niveau de l'intestin; mais elles augmentent la fréquence des lachages pour les sutures coliques éversantes la soie (6) Les anastomoses faites avec un appareil à suture automatique, à la 24ème heure d'une péritonite par perforation, après 48 heures de dévascularisation intestinale ou 48 heures d'obstruction, donnent la mÊme sécurité que les anastomoses inversantes.

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Authors and Affiliations

  1. Department of Surgery, The University of Pittsburgh, USA

    Mark M. Ravitch M.D., Robert Brolin M.D., Joseph Kolter M.D. & Simon Yap M.D.

  2. Montefiore Hospital, Pittsburgh, Pennsylvania, USA

    Mark M. Ravitch M.D., Robert Brolin M.D., Joseph Kolter M.D. & Simon Yap M.D.

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  1. Mark M. Ravitch M.D.
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  2. Robert Brolin M.D.
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  3. Joseph Kolter M.D.
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  4. Simon Yap M.D.
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Ravitch, M.M., Brolin, R., Kolter, J. et al. Studies in the healing of intestinal anastomoses. World J. Surg. 5, 627–633 (1981). https://doi.org/10.1007/BF01655019

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