Safety and effectiveness of mechanical versus hand suturing of intestinal anastomoses in an animal model of peritonitis

Abstract

Abstract. Mechanical stapling for colorectal anastomosis is popular, but the safety of its use for anastomosis in peritonitis is unclear. We evaluated the safety and effectiveness of mechanically stapled vs. hand-sutured anastomosis by comparing wound healing in an animal model of bacterial peritonitis. Male Sprague-Dawley (n=48) rats underwent cecal ligation and puncture. After 24 h, rats were divided into two groups: the stapler group (cecal resection with mechanical stapler, n=24) and the hand-sutured group (cecal resection and stump closure with surgical absorbable suture, n=24). Anastomotic segments were excised and as indicators of wound healing, anastomotic bursting pressure (ABP) and tissue hydroxyproline concentration were determined over time. After harvesting, anastomotic segments were analyzed by quantitative real-time polymerase chain reaction (PCR) to determine relative expression of transforming growth factor-β 1 (TGF-β 1 ) and vascular endothelial growth factor (VEGF) normalized to that of a constitutive gene. The operative time was significantly shorter in the stapler vs. the hand-sutured group. Both groups showed progressive increases in ABP over the postoperative period. ABP was significantly higher in the stapler vs. the hand-sutured group on postoperative days (PODs) 0 and 3. Tissue hydroxyproline concentration increased from POD 7 in both groups, but between-group difference was not significant. Both groups showed progressive increases in TGF-β 1 and VEGF expression during the 7-day postoperative period. On POD 5, TGF-β 1 gene expression was higher in the stapler vs. the hand-sutured group. VEGF gene expression was identical in both groups. In conclusion, anastomosis by stapler is safer and more effective than that by hand suturing in bacterial peritonitis, since it requires less operating time and creates stronger anastomoses in the early postoperative period. IntroductionAnastomotic dehiscence following gastrointestinal surgery, particularly colorectal surgery, is a significant cause of morbidity and mortality, and leakage from colonic anastomosis is a major concern for surgeons. The incidence of reported anastomotic leakage varies between 10 and 13% (1,2). Presently, the use of mechanical staplers for colorectal anastomoses has been increasing and is becoming widely accepted in Western countries due to the short procedure time and reliability afforded by this technique. It has reduced the operation time, has facilitated the performance of gastrointestinal anastomoses at sites with a poor field of view and has decreased the likelihood of suture failure (3,4). Several prospective randomized controlled studies have compared hand suturing with mechanical stapling in patients undergoing total gastrectomy and low anterior colorectal resection (5-7). However, hand-sutured anastomoses are still popular due to economic conditions in developing countries, and few experimental studies have yet been reported comparing wound healing of stapled anastomosis with hand-sutured anastomosis, particularly i...

Development of a standardized laparoscopic caecum resection model to simulate laparoscopic appendectomy in rats

“…Appendectomy models have historically been useful in a variety of research fields. In CA models, for example, electrosurgical devices (bipolar cautery [ 11 , 14 ], LigaSure Precise [ 12 , 14 ]), endoclips [ 12 - 14 ], endoloops [ 13 , 23 ] and staplers [ 13 , 15 ] have been compared, and all investigated methods have been shown to be feasible, safe and leakproof. While some of the LA rat models also investigated caecum resection and closure techniques, other groups focused on topics such as postoperative immune function [ 16 , 17 , 21 , 24 ], risk of neoplastic port site metastasis after LS [ 18 , 23 ], influence of taurolidine/heparin on local tumour growth after laparoscopy [ 20 , 22 ] and postoperative adhesion formation [ 19 ].…”

“…Indeed, the idea of using rats to simulate an appendectomy is not new. Several recent studies investigated open caecum resections in rats for this purpose [ 6 - 10 ], some of which examined laparoscopic techniques [ 11 - 15 ]. However, the data available on laparoscopic caecum resection in rats is scarce; small cohorts of animals have been used and incomplete procedural descriptions have been presented by some authors [ 16 - 24 ].…”

Advances in laparoscopic surgery in urology

“…Furthermore, linear staplers have an important role in robotic radical cystectomy with intracorporeal creation of a neobladder to perform ileoileal anastomosis 33 . In 2012, Tajima et al 34 compared stapled and handsutured intestinal anastomoses in a rat model of peritonitis. Anastomosis by stapler proved to be safer and more effective than by hand suturing, as operating time was reduced (9.1 min versus 15.9 min, P <0.001) and it created stronger anastomoses (median bursting pressure 85 mm Hg versus 60 mm Hg, P <0.05) in the early postoperative period (postoperative day 3).…”