Comparison of Strength of Anastomosis Between Four Different Techniques for Colorectal Surgery

Abstract

Background/Aim: Advances in stapling devices have led to their widespread use in colorectal surgery. We compared the strength of four types of anastomoses using bursting pressure. Materials and Methods: We created stapled anastomosis models [double stapling technique (DST), functional end-to-end anastomosis (FEEA) unbuttressed or buttressed, and triangulating anastomosis (TA) with two-or three-row stapling] and a hand-sewn anastomosis model. Bursting pressures of each method were measured. The primary end point was the bursting pressure. The effectiveness of buttressing and three-row stapling were the secondary endpoints. Results: The DST group had significantly lower bursting pressure than TA with three-row stapling, FEEA buttressed, and hand-sewn groups. No significant difference was found between the bursting pressure of the FEEA unbuttressed and FEEA buttressed groups and that of the TA with two-row and three-row stapling groups. Conclusion: DST has the lowest bursting pressure compared to other anastomotic techniques. Buttressing suture and three-row stapling have no effect on the strength of anastomosis.

New Anastomosis Technique to Prevent Anastomotic Leakage in Laparoscopic Anterior Resection for Rectal Cancer, Especially Upper Rectal Cancer

“…In a comparison of the single stapling technique, DST, and side-to-side technique, we showed that the strongest anastomosis was the side-to-side anastomosis created by a circular stapler. This result was as same as previously reported study by Tomori et al (22). Therefore, we introduced a side-to-side anastomosis technique (the CST) in colorectal anastomosis to prevent AL.…”

An experience of total laparoscopic partial colectomy with intracorporeal triangulating anastomosis in an obese patient with descending colon cancer

“…In this technique, a shorter section of the intestinal tract is used to create the anastomosis, and the form of anastomosis is similar to a physiological end‐to‐end anastomosis 8 . A previous in vivo experimental study examining the strength of various stapled anastomotic techniques indicated that the triangulating anastomoses are more high pressure‐resistant than other kinds of anastomosis 6 . On the basis of these results, we considered that this technique is an appropriate anastomotic technique for use in laparoscopic surgery.…”

“…The stapled anastomosis technique is simple and reduces the duration of surgery and the stress experienced by surgeons. 6 Triangulating stapling technique was introduced for open colorectal anastomosis procedures in 1993, 7 and it is considered to create less leakage than other techniques. 5 In this technique, a shorter section of the intestinal tract is used to create the anastomosis, and the form of anastomosis is similar to a physiological end-to-end anastomosis.…”

“…8 A previous in vivo experimental study examining the strength of various stapled anastomotic techniques indicated that the triangulating anastomoses are more high pressure-resistant than other kinds of anastomosis. 6 On the basis of these results, we considered that this technique is an appropriate anastomotic technique for use in laparoscopic surgery. However, this methods required at least five staplers and its cost was expensive compared with other intracorporeal stapled anastomoses, which was the biggest issue.…”

“…In intracorporeal anastomosis procedures, stapled anastomosis methods are considered to play an important role in overcoming the technical difficulty of laparoscopic surgery. The stapled anastomosis technique is simple and reduces the duration of surgery and the stress experienced by surgeons 6 …”