[Technique and quality of laparoscopic hand-sewn intestinal anastomoses in an experimental procedure].
In conventional surgery running suture of all intestine layers is used commonly. Therefore we have tested the following manual running suture technics for laparoscopic surgery using animal experiments. 1. Turnover technic: suture of front and back-wall from outside by using holding sutures. 2. Non-turnover-technic: special holding sutures to fix the back-wall and sewing from the inside followed by the front-wall from outside. 3. Clamp-technic: By using two special parallel closing clamps (Endo-Gauge) with a suture from inside and outside. The ends of the anastomosis are well fixed without additional suture. All animals (n = 15) survived without complications, without leakage of the anastomosis and only one third developed intraabdominal fusions. The main difference was in time performing the anastomosis: 64 min. for the turnover technic, 52 min. for the non-turnover technic and only 25 min for the clamp technic without holding sutures. According to this results, we start to design a new bowel-clamp for sewing laparoscopic anastomosis. Therefore it is possible to perform a laparoscopic manual running suture in a reasonable amount of time. Furthermore the laparoscopic manual suture is a good alternative to the stapler technic because it is much less expensive and leaves no foreign materials.
Schüder
G
G
Abteilung für Allgemeine Chirurgie, Abdominal- und Gefässchirurgie, Universität des Saarlandes, Homburg/Saar.
Pistorius
G
G
Plusczyk
T
T
Hildebrandt
U
U
D000714:Anastomosis, Surgical / Q000295:instrumentation*; D000818:Animals; D005260:Female; D007421:Intestine, Small / Q000473:pathology / Q000601:surgery*; D020706:Laparoscopes; D008297:Male; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine; D014945:Wound Healing / Q000502:physiology