Experimental oesophagogastric anastomosis: preliminary report of a new compression device that also fragments

An investigation of the effects of suture patterns on mechanical strength of intestinal anastomosis: an experimental study

How the distance of sutures from the edge of tissue and the horizontal distance between stitches affect the mechanical strength of anastomosis is investigated. In this study, 180 bovine intestines were used to investigate the optimum pattern in 18 groups by considering a 4, 6, and 8 mm horizontal distance between stitches, and a 3, 5, and 7 mm distance from the edge of tissue with 3-0 Silk and 3-0 PDS sutures to maximize the strength of anastomosis (10 specimens in each group). Also, 80 specimens were used to investigate the maximum effective distance of sutures from the edge of tissue in eight groups of: 3, 5, 7, and 10 mm distance from the edge, with the same type of sutures. Tensile tests with an elongation rate of 5 mm/min were performed for all the groups. Based on the results, the pattern of 7-6 (distance from the edge-distance between stitches) for both 3-0 Silk and 3-0 PDS, 5-6 and 7-4 for 3-0 Silk, and 5-6 and 7-4 for 3-0 PDS can be considered as the best options among 18 different combinations. It was also found that increasing the distance from the edge from 7 mm to 10 mm does not cause a significant difference in mechanical strength. Results can help surgeons to improve the intestinal anastomosis and employ it as an input for automatic suturing devices.

Experimental Procedure of Compression Anastomosis Using Fragmented Rings: A Porcine Model

BACKGROUND

Compression anastomosis has been recently abandoned because of a nonsuperiority compared to stapling anastomosis. Nonremoval of the rings has frequently been reported and this technique does not support a routine use. The aim of this experimental study was to assess the feasibility of anastomosis using compression with a device consisting of fragmented rings.

METHODS

A new compression device, the "Anastocom," was compared to standard double-stapled colocolonic anastomosis in 2 groups of 8 pigs. In each group, colocolonic anastomosis was performed with a circular stapler (DST Series EEA Staplers) in 4 pigs and with the Anastocom device for the other 4 pigs.

RESULTS

The anastomotic rings were expelled between postoperative day 7 and day 13 from the 4 animals sacrificed at day 30. The anastomosis was clean and intact in all pigs. After sacrifice, there was no difference in the bursting pressure at day 7 ( P = .226) or at day 30 ( P = .885) between the 2 types of anastomosis. After sacrifice at day 7, the mean bursting pressure values for the Anastocom and EEA anastomoses were 128.6 mm Hg (range 119-143 mm Hg) and 218.9 mm Hg (range 84-240 mm Hg), respectively. After sacrifice at day 30, the mean bursting pressure values for the Anastocom and EEA anastomoses were 111 mm Hg (range 59-234 mm Hg) and 105 mm Hg (range 81-130 mmHg), respectively.

CONCLUSION

No bowel obstruction was observed with Anastocom. This fragmentation mechanism should better prevent nonexpulsion compared to basic compression anastomosis.

Circular 'superelastic' compression anastomosis: from the animal lab to clinical practice

The recent development of a compression device using shape memory Nitinol technology to create an end-to-end anastomosis has renewed the interest in sutureless anastomotic techniques. A phase II, prospective open label clinical trial was started in May 2007 to evaluate the feasibility and safety of this new anastomotic device. Fourty patients who need left colectomy or high anterior resection for either diverticular disease or adenocarcinoma will be recruited in two academic hospitals (Uppsala,Sweden and Leuven, Belgium). Clinical leakage is the primary endpoint. Only preliminary results are available to date as the recruitment is ongoing. The median age of the first ten patients is 57.5 years (44-72). No anastomotic leakage occurred. The median hospital stay was 4.0 days. Only three patients noticed the passage of the ring through the anal canal. By three weeks no ring was sustained in the gastrointestinal tract as was objectified by plain X-ray. First clinical use of this new anastomotic device seems promising. Final results for the total phase II trial are awaited. A prospective randomized trial to compare the efficacy of the EndoCar 28 with conventional stapling should be the next step.

Compression anastomosis clip for gastrointestinal anastomosis

AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction.

METHODS: Sixty-six patients undergoing gastrointe-stinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler.

RESULTS: The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis.

CONCLUSION: CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further confirmed with a larger patient sample.

Strength of Esophageal Closure Techniques With and Without Tissue Reinforcement

OBJECTIVES

The purpose of this study was to investigate the effects of esophagotomy closure techniques on the esophageal bursting pressure.

MATERIALS AND METHODS

Altogether, 122 freshly dead sheep esophagi received from the local slaughterhouse were prepared for manual closure. After esophagotomy, the specimens were divided into four groups. An interrupted mucosal suture pattern (n = 30), an interrupted mucosal-submucosal suture pattern (n = 30), an interrupted mucosal-submucosal + over-over continuous muscular suture pattern (n = 32), and an interrupted mucosal-submucosal + reinforcement with a diaphragmatic part with full-thickness interrupted U suture pattern (n = 30) were used for esophagotomy closure; 4-0 silk was used in all specimens. Bursting pressures were measured with a sphygmomanometer.

RESULTS

We found a statistically significant difference among the bursting pressures of all groups (p < 0.001). The bursting pressure values gradually increased from group 1 to group 4 (47.6 +/- 22.7, 86.2 +/- 49.5, 185.4 +/- 53.5, and 226.8 +/- 62.4 mmHg, respectively). Reinforcing the esophageal suture line with tissue significantly increased the bursting pressure compared to the other groups.

CONCLUSIONS

Each layer of the esophagus significantly contributes to strengthening esophageal wall tension with primary esophageal closure, and reinforcement of the esophageal suture with tissue provides an additional significant increase in the bursting pressure of the esophagus.