Ex vivo comparison ofhand‐suturedversus circular stapled anastomosis in canine large intestine

Abstract

Objective To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand‐sewn techniques in dogs. Study design Ex‐vivo study. Animals Colon from 11 canine cadavers. Methods Thirty‐two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand‐sewn colonic anastomoses performed with 4‐0 glycomer 631 (G) and 4‐0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End‐to‐End Anastomosis (EEA C4.8mm) and 3.5 mm End‐to‐End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon. Leakage pressure was defined as the pressure at which dye‐containing solution was first observed to leak from the anastomosis site. Results Leakage pressures were 49.5 mmHg (range:16‐72) in group G, 45.5 mmHg (range:19‐80) in group BG, 5.3 mmHg (range:0‐31) in group C3.5mm, and 29.5 mmHg (range:23‐50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand‐sewn (C4.8mm‐G p = .0313, C4.8mm‐BG p = .0131, C3.5mm‐G p = .0469, C3.5mm‐BG p = .0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg. Conclusion End‐to‐end colonic anastomoses closed with circular stapler leaked at lower pressures than hand‐sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses. Clinical significance These results provide evidence to support hand‐suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.

Influence of conventional versus unidirectional barbed suture on leakage pressures in canine vesicourethral anastomosis: An ex‐vivo study

“…Samples were immediately tested after completion of the anastomosis following a previously published technique 14,15 . An 11 cm long, 8 Fr.…”

“…Samples were immediately tested after completion of the anastomosis following a previously published technique. 14,15 An 11 cm long, 8 Fr. introducer (Super Arrow-Flex Introducer Set; Arrow International, Inc., Reading, Pennsylvania) was inserted in the urethra and secured with two circumferential sutures using 3-0 Glycomer 631 (Biosyn, Medtronic, Minneapolis).…”

Simple Continuous Versus Cushing Suture for Jejunal end-to-end Anastomosis in the Dogs: a Comparative Study

“…Our data show that the inverting Cushing suture withstands higher luminal pressures. Other studies that compared initially the leak pressure of four anastomosis technique (1) handsewn anastomosis (HSA), (2) barbed suture anastomosis (B-HSA), (3) stapled functional end-to-end anastomosis (SFEEA), and (4) stapled functional end-to-end anastomosis with an oversew (SFEEA-O)] revealed no differences between the techniques tested in cooled canine cadaveric jejunum (Fealey et al, 2020), although other authors following ex vivo testing of hand-sutured versus circular stapled anastomosis in canine large intestine concluded that end-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses (Sapora et al, 2021). Vicryl is commonly used for intestinal anastomosis in humans with good published success and is popular in Europe for veterinary use.…”