Despite the Effects of Tension and Intraluminal Pressure, Which Suture Technique Is the Most Appropriate for Prevention of Air Leakage or Anastomotic Dehiscence in Tracheal Anastomoses in the Short Term? An Experimental Research on Ex Vivo Model

Abstract

Purpose: We performed an experimental study comparing different suture techniques in trachea anastomoses using the ex vivo sheep model, which deals with the parameters that suture tension, air leakage, intraluminal pressure, and tension at which the anastomosis will rupture. We aimed to find an answer to “Which suture technique should be used in tracheal anastomoses?”Methods: In all, 45 sheep tracheas were randomly divided into three groups (each n = 15) differing in suture technique for anastomoses: single stitches, mixed, and continuous suture. The anastomoses were evaluated for air leakage under normal (25 mbar) and high (70 mbar) intraluminal pressures without tension. Then, air leakage was followed under high intraluminal pressure with tensile stress. Tension levels of dehiscence were also recorded. Data were statistically evaluated.Results: No air leakage was observed at 25 mbar intraluminal pressure. At 70 mbar pressure without tension, no statistically significant difference was found among the groups (p >0.05). However, single-stitch technique was the best in terms of air leakage tension and rupture tension levels (p <0.05).Conclusion: The most reliable and advantageous is single-stitch technique for a tracheal anastomosis in short-term results. Further studies are needed to analyze longer ventilation periods in terms of other serious complications as ischemic dehiscence and stenosis.

Application of transanal tube after anterior rectal resection: Impact on prevention of "Achilles heel" in colorectal surgery

“…Although a statistically significant interaction effect has not been proven, our analysis suggests that patients with DM2 may derive particular benefits from this intervention. A review O n l i n e f i r s t of available medical literature didn't identify studies investigating the mentioned interaction, but based on the results of our study, it appears that placing TnT through colorectal anastomosis has the potential to compensate for what is compromised in patients with DM2, such as microcirculation and wound healing (27,28,32). The definitive cause of this phenomenon could be complex and requires further research to establish the exact relationship between the presence of DM2 and the benefits of TnT after surgery.…”

“…Previous studies suggest that TnT reduces endoluminal pressure in the intestinal anastomotic segment and allows drainage of exudate on the proximal side of the anastomosis, facilitating healing and reducing the risk of AL (31,32). It also acts as a barrier against contamination of the anastomosis by fecal material from the intestinal lumen, reducing the risk of infection and aiding in maintaining its mechanical stability (33,34).…”

Effect comparison of three different types of transanal drainage tubes after anterior resection for rectal cancer

“…Endoluminal pressure is presumed to be associated with AL [23]. TDT can continuously discharge fluid, gas and feces from the proximal large intestine to reduce endoluminal pressure and contamination of the anastomotic site; TDT can also continue to dilate the anus, relieve the closure of the anus, reduce the anastomotic tension, and increase the blood supply of the anastomosis.…”

Surgiflo®may have a potential impact on the healing process in cricotracheal resection anastomosis

“…Because postoperative cough or mechanical ventilator monitoring is frequently associated with tracheal resections, a tracheal surgery without increased intraluminal pressure is not possible. Therefore, the high intraluminal pressure and high anastomosis tension are not rare cases and are the routine problems of daily practice 41 . Therefore, the authors believe in the importance of using the flowable haemostatic matrices like Surgiflo ® in tracheal resection anastomosis surgeries with purpose of enhancing healing at the site of anastomosis, filling the proposed micro gaps that may occur due to anastomosis dehiscence and to overcome tensions usually created there.…”