Comparative surgical and colonoscopic appearance of colon anastomoses constructed with sutures,staples, and the biofragmentable anastomotic ring |
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Authors: | Charles A. Bundy Richard T. Zera Gerald A. Onstad Laura L. Bilodeau Melvin P. Bubrick |
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Affiliation: | (1) Department of Surgery, Medicine and Pathology, Hennepin County Medical Center, 701 Park Avenue South, 55415 Minneapolis, MN, USA |
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Abstract: | 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. |
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Keywords: | Colon Anastomosis Colonoscopy |
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