Summary
The following animal study was undertaken to compare and assess the endoscopic gross appearance and histology of colonic anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring (BAR).Methods: Three anastomoses—1 BAR, 1 stapled, and 1 sutured—were placed in each of 48 dogs and colonoscopy and anastomotic evaluation were done.Results: No leaks were found by air insufflation at surgery. Grossly, the BAR had serosal hematomas in 27/48 anatomoses vs 7/48 for stapled and 1/48 for sutured (BAR vs stapledP<0.0005 and sutured vs stapledP=0.07). Adhesions were significantly greater for BAR (35/36) and sutured (34/36) compared to stapled (26/36) (BAR vs stapledP=0.01 and sutured vs. stapledP=0.04). Colonoscopic exams at days 3, 7, and 28 showed no significant difference among groups with respect to bleeding, ulceration, necrosis, granulation, or contour. Sutured anastomoses were more stenotic (24/31) than stapled (4/31) or BAR (3/31) ones (BAR vs sutured and sutured vs stapledP<0.005). At 28 days, 10/10 sutured vs 2/10 stapled vs 3/10 BAR were stenotic (BAR vs suturedP=0.02, sutured vs stapledP=0.01). Inflammation on histologic exam at 28 days was not significantly different: sutured (12/12), stapled (12/12), or BAR (9/12). Fibrosis was more prominent in sutured (12/12) than in stapled (5/12) or BAR (4/12) anastomoses (BAR vs suturedP=0.001, sutured vs stapledP=0.004, and BAR vs stapledP=1.00). All anastomoses healed primarily without necrosis or obstruction.Conclusions: (1) Colonoscopy to evaluate anastomoses can be done safely even in the early postoperative period. (2) The BAR anastomoses had the most serosal hematomas; BAR and sutured had more adhesions than stapled anastomoses; and sutured anastomoses had the most stenosis and fibrosis. None of these differences was of clinical significance.
Similar content being viewed by others
References
Arey L (1936) Wound healing. Physiol Rev 16: 327–406
Ballantyne GH (1984) The experimental basis of intestinal suturing: effect of surgical technique, inflammation, and infection on enteric wound healing. Dis Colon Rectum 27: 61–71
Chardavoyne R, Ratner LE, Jaume JC, Stein TA, Greenberg R, Bank S, Wise L (1989) Safety of endoscopy in the immediate postoperative period following gastric anastomosis. Surg Endosc 3: 13–15
Getzen LC, Roe RD, Halloway CK (1966) Comparative study of intestinal anastomotic healing in inverted and everted closures. Surg Gynecol Obstet 123: 1219–1227
Gilbert JM, Trapnell JE (1988) Intraoperative testing of the integrity of left-sided colorectal anastomoses: a technique of value for the surgeon in training. Ann R Coll Surg Engl 70: 158–160
Halsted WS (1887) Circular suture of the intestine: and experimental study. Am J Med Sci 94: 436–461
Maney JW, Katz AR, Li KK, Pace WG, Hardy TG (1988) Biofragmentable bowel anastomosis ring: comparative efficacy studies in dogs. Surgery 103; 1: 56–62
Whipple AO (1933) The use of silk in repair of clean wounds. Ann Surg 98: 622–671
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bundy, C.A., Zera, R.T., Onstad, G.A. et al. Comparative surgical and colonoscopic appearance of colon anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring. Surg Endosc 6, 18–22 (1992). https://doi.org/10.1007/BF00591182
Issue Date:
DOI: https://doi.org/10.1007/BF00591182