Anastomoses in the alimentary tract using a sero-muscular tubular cuff technic

Telescoping anastomosis of the colon: a comparative study

The incidence of large-intestinal anastomotic leaks remains unacceptably high. For this reason, we studied the resistance to dehiscence of a telescoping type of anastomosis and compared it with the conventional one-layer, two-layer, and stapled anastomoses in a canine model. These experiments demonstrated that the telescoping anastomosis provided a more resistant suture line during the early postoperative phase and did not cause encroachment of the lumen by the diaphragm, which was consistently produced when an inverting suture line was used. Three days postoperatively the mean bursting pressures of the one-layer, two-layer, and stapled anastomoses were 31 +/- 12, 120 +/- 46, and 52 +/- 21 mm Hg, respectively. The telescoping anastomosis had a mean bursting pressure of 210 +/- 44 mm Hg, which was significantly (P less than 0.01) higher than those of all the other anastomoses tested. However, seven and 14 days after operation, there was no statistically significant difference among the bursting pressures of the various anastomoses. When the different types of anastomoses were examined histologically, it was found that there was considerably more suture-line inflammation, edema, micro-abscess formation, mucosal ulceration and pericolic inflammation of the fat in the one-layer, two-layer, and stapled anastomoses than in the telescoping anastomosis.

Colonic anastomosis-a new approach: preliminary report

The exact incidence of colonic anastomotic breakdown is difficult to assess. The low incidence reported on the basis of clinical observation only is misleading, since it has been demonstrated that leakages occur without clinical manifestation. Better evaluation of the rate of incidence will require meticulous postoperative investigation, as shown by Goligher. A new colonic anastomosis was performed in 24 cases of high and low anterior resections. The principal of forming a seromuscular cuff has been employed. The encouraging results merit further trial.

Experimental gut anastomoses and their revascularization

A study was made of the healing and revascularization of intestinal anastomoses in the small and large intestines of rabbits. Single-layer and double-layer suture, techniques were used and compared, and revascularization of the anastomoses was particularly examined after devascularization of their distal segments. The anastomotic segments were removed at intervals after construction varying from one to six weeks and studied histologically after haemotoxylin and eosin staining, by xylol-clear thick sections and by angiography, a gelatin Micropaque emulsion being used to fill the vascular network. Forty-four rabbit intestinal anastomoses were studied. Inverted intestinal anastomoses took about two weeks to develop continuous mucosa on the luminal side, and were completely healed after six weeks. Revascularization began after eight days with both single-layer and double-layer anastomoses, proceeding from the submucosal and the surrounding muscular layers. The vascular pattern mirrored the healing stage of the anastomosis. Irregular fine vessels crossing the anastomoses were seen in specimens examined at the second week. After three or four weeks, the vascular patterns of the anastomoses showed an irregularity of calibre and direction because of the presence of residual scar tissue, and the mucosal surfaces were covered with regenerating epithelium. Healing and revascularization were complete after six weeks.