Comparative study of hand sewn single layer anastomosis of dog's bowel.
BACKGROUND
Two-layer intestinal anastomosis increases the inflammatory response while single-layer anastomosis results in a better wound healing. However the four main kinds of stitches which may be chosen in performing single layer intestinal sutures never before had been comparatively studied.


OBJECTIVE
To compare the four more commonly used types of single layer surgical anastomosis sutures of the digestive tract.


METHODS
Six mongrel dogs were operated, each one receiving two anastomosis: one at 30 cm from de Treitz angle - sero-submucosal technique, and the other at 60 cm - total technique. This placement was alternatively inverted. The four more commonly used types of single layer surgical anastomosis sutures of the digestive tract, namely: sero-submucosal stitches tied in the lumen, over the submucosa; sero-submucosal stitches tied in the exterior of the organ, over the serosa; total stitches tied in the lumen, over the mucosa; and total sutures tied in the exterior, over the serosa (Gambee's stitches) were tested. After euthanasia (7th post-operative day) macro and microscopic features were evaluated. Friedman's test was applied for morphometry and for evaluation of the peritoneal adhesions.


RESULTS
Statistical significance was demonstrated through major residual acute inflammation and proliferation in total sutures and more profuse adhesions with the sero-submucosal stitches tied in the lumen. The sero-submucosal stitches tied in the exterior over the serosa, had excellent realignment and regeneration of the layers.


CONCLUSIONS
The sero-submucosal stitches tied in the exterior, over the serosa, were the best ones.
Azevedo
João Luiz Moreira Coutinho
JL
Division of Operative Techniques and Experimental Surgery, Department of Surgery, Center of Minimally Invasive Surgery, UNIFESP, São Paulo, SP, Brazil. jozevedo.dcir@epm.br
Hypólito
Octávio
O
Azevedo
Otávio Cansanção
OC
Becker
Otávio Monteiro
OM
Freire
Dalmer Faria
DF
D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000818:Animals; D002455:Cell Division; D004285:Dogs; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery*; D023421:Models, Animal; D010532:Peritoneal Diseases / Q000209:etiology; D012704:Serous Membrane / Q000473:pathology / Q000601:surgery*; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects; D000267:Tissue Adhesions / Q000209:etiology