Comparison of skin staples with sutures for anastomosis of the small intestine in dogs.
OBJECTIVE
To develop a technique for approximation of end-to-end intestinal anastomoses by using a disposable skin stapler and to compare the stapling technique with an interrupted hand-sewn approximating end-to-end anastomosis of the canine jejunum.


METHODS
In vitro evaluation of the stapling technique, followed by an in vivo study of healing and clinical response in dogs.


METHODS
18 mixed-breed adult dogs.


METHODS
The anastomotic technique was developed and tested in fresh canine jejunum. Fourteen stapled approximating anastomoses (SAA) and 14 hand-sewn approximating anastomoses (HAA) were performed in 6 cadavers under simulated surgical conditions. Anastomotic construction times, initial bursting strengths, initial lumen diameters, and gross appearance of the 2 techniques were compared. Healing and clinical response were evaluated in 12 purpose-bred dogs assigned to 2 groups of 6 animals each. Each dog had 1 SAA and 1 HAA performed in the jejunum, 50 cm apart. Six dogs were killed on postoperative day 4, and 6 dogs were killed on postoperative day 21. Anastomotic construction time, gross and histological healing, bursting strength, lumen diameter, and circumference were compared between techniques.


RESULTS
Mean construction time for SAA was significantly faster than for HAA (P = .0001). None of the anastomoses leaked, and there were no major clinical complications in any dog. Bursting strengths were not significantly different at any time for the 2 techniques. Initial bursting strength was 31% to 35% of the normal jejunum. A nonsignificant decrease in bursting strength was observed by postoperative day 4 (26% to 28% of normal), and a significant increase in bursting strength was observed by postoperative day 21 (100% to 109% of normal). Neither technique decreased the initial lumen diameter. However, both techniques resulted in a similar degree of luminal stenosis as the anastomoses healed. Anastomotic lumen diameter was significantly decreased from normal in both groups at day 4 (86% to 88% of normal) and day 21 (90% to 91% of normal). There was no significant difference between the circumference of the anastomoses and normal jejunum at any time. Histological analysis showed similar healing for the hand-sewn and stapled techniques at 4 and 21 days after surgery. For both surgical techniques, day 21 anastomoses had significantly less inflammation and necrosis, significantly more fibrosis, and significantly better continuity of histological layers when compared with day 4 anastomoses.


CONCLUSIONS
Approximating end-to-end intestinal anastomosis with a skin stapler is equivalent in bursting strength, lumen diameter, lumen circumference, and healing characteristics to the traditional hand-sewn technique, but it can be performed in significantly less time.


CONCLUSIONS
Skin stapling devices can be used to create technically simple, rapid, and safe end-to-end anastomoses in canine jejunum.
Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, USA.
B R
BR
Coolman
N
N
Ehrhart
G
G
Pijanowski
E J
EJ
Ehrhart
S L
SL
Coolman
D000714:Anastomosis, Surgical / Q000662:veterinary; D000818:Animals; D001696:Biomechanical Phenomena; D004285:Dogs / Q000601:surgery*; D005260:Female; D007583:Jejunum / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D017792:Surgical Stapling / Q000662:veterinary*; D013536:Suture Techniques / Q000662:veterinary*; D016896:Treatment Outcome; D014945:Wound Healing