Comparison of catgut and polyglycolic acid sutures in colonic anastomoses

Anastomotic Techniques for Abdominal Crohn's Disease: Tricks and Tips

After surgical resection for Crohn's disease (CD) endoscopic recurrence is noted within few weeks and almost 80% of patients will have evidence of endoscopic recurrence at the anastomosis after ileocolic resection at 1 year. With time and if left untreated surgical recurrence will be detected at the preanastomotic segment or at the anastomosis in the vast majority of cases. It has become progressively apparent also based on these historical data that anastomotic configuration plays a major role in the subsequent recurrence of CD in surgically induced remission. In this article, we will review the evidence in the literature to support the different anastomotic configurations and we will discuss the principles of surgical prophylaxis of CD recurrence.

Influence of suture technique on anastomotic leakage rate-a retrospective analyses comparing interrupted-versus continuous-sutures

PURPOSE

While many hospitals consider a continuous sutured colonic anastomosis with monofilamental fiber the current state of the art, others have advocated for interrupted sutures as the gold standard. The aim of the study was to evaluate the influence of suture technique on leakage rate (primary endpoint), wound infections, postoperative stay, and mortality.

METHODS

Retrospective analyses of 347 patients (273 elective, 74 urgent) over 6 years with a handsewn colonic anastomosis (190 interrupted, 157 continuous), excluding sigma and rectum anastomosis. Demographic and surgical baseline characteristics were used as competing predictors.

RESULTS

Overall leakage rate was 9% but strongly dependent on suture technique (interrupted: 16%; continuous: 2.5%; p = 0.001) yielding an odds ratio of 5.10 [95% CI: 2.55, 6.71] (relative risk of leakage). No other variable showed a significant influence on leakage rate. Postoperative stay was prolonged in the interrupted suture group (23 ± 15 vs. 16 ± 11 days; p = 0.000, attributable effect 7.5 days [4.7, 10.3]).

CONCLUSIONS

Our results indicate a highly significant reduction of anastomotic leakage rate and postoperative stay that generalize to the underlying population by continuous sutures in handsewn colonic anastomosis. In the absence of randomized prospective studies, the current results provide the yet strongest evidence for the superiority of continuous sutures.

Collagen dynamics of partial small bowel obstruction

The response of intestinal collagen to obstruction and stress was studied in the rat. Partial small bowel obstructions were created. Preobstruction collagen was measured by injection of tritium labeled proline. New collagen formation after obstruction occurred was followed by injection of carbon-14 labeled proline. At 3 weeks, collagen fractions were identified. Throughout the study, preexisting preobstruction intestinal collagen was metabolically stable with no breakdown or remodeling demonstrable. New collagen formation was rapid and occurred to the largest degree close to the obstruction.

Collagen formation during the healing of colonic anastomoses

To study new collagen formation in the healing of anastomoses in the right colon, five male Sprague-Dawley rats had single-layer colonic anastomosis performed. Five additional rats had suture of the colon with interrupted sutures without transection of the colon. Ten animals served as controls. One week after surgery, animals were given 3H-proline repeatedly to label new collagen formation during the second and third weeks. Animals were sacrificed three weeks after suturing or anastomosis. Two- or 10-mm segments were precisely excised on either side of the suturing or anastomoses. Total collagen and its total radioactivity were measured per segment. Collagen hydroxyproline and its radioactivity increased (100 per cent) only within 1 cm of the anastomosis or suture alone. No local or distant decrease in collagen was observed. Collagen formation in colonic wounds appears to be a local process.