An alternative to conventional hand-sewing colocolic anastomosis: anastomosis with absorbable surgical barrier film without sutures.
OBJECTIVE
As a result of its high morbidity and mortality rates, anastomotic leakage is one of the most feared complications in colorectal surgery. Therefore, this issue is one of the most relevant in colorectal surgery and a lot of work has been conducted to research it. The aim of this experimental study was to compare colocolic anastomosis performed by using absorbable surgical barrier film without suture and conventional anastomosis performed by hand-sewing technique in terms of anastomosis safety.


METHODS
In this study, 40 Norway Wistar Albino 3-month-old female rats were used. Each weighed between 250 and 300g. The rates were divided into two groups, a control group and an experimental group. Full-thickness incisions were made on the ascending colon of both groups of rats. The control group's anastomoses were conducted using a hand-sewn technique consisting of one layer of nonabsorbable sutures (Gambee suture). The experimental group's anastomoses were performed using absorbable surgical barrier film without sutures. Afterwards, sample pieces of the anastomosis area were taken from all rats on either the 3rd or the 7th day following the operation, resulting in subgroups that led to a total of four test groups. The samples taken were subjected first to an anastomosis bursting pressure test followed by histopathological examinations and a test to detect the levels of hydroxyproline in the tissue.


RESULTS
The control groups (groups 1 and 3) had average anastomotic bursting pressures of 33.0±9.49mmHg and 146.0±15.06mmHg respectively, whereas experimental groups (groups 2 and 4) had average anastomotic bursting pressures of 58.0±10.33mmHg and 190.0±25.82mmHg respectively. Mann-Whitney U-test analysis of the bursting pressure values indicates the differences between groups 1 and 2 (3rd day postoperatively) and groups 3 and 4 (7th day postoperatively) to be statistically significant (P=0.0001 and P=0.0003 respectively). Values obtained from histopathological staging conducted according to the Ehrlich-Hunt model where the evaluation criteria in this model are: amount of inflammatory cells, fibroblasts, neovascularization and collagen and which were analysed using the Mann-Whitney U-test have shown no significant difference between 3rd day postoperatively groups 1 and 2 (P=0.579) while the difference between 7th day postoperatively groups 3 and 4 was found to be significant (P=0.023). Average levels of hydroxyproline in the tissue were 88.18±8.04mg/l for group 1, 56.31±5.40mg/l for group 2, 135.0± 6.30mg/l for group 3 and 100.2±15.42mg/l for group 4. Analysis of values in the groups using the Mann-Whitney U-test indicate a significant difference (P < 0.0001) both between groups 1 and 2 and between groups 3 and 4.


CONCLUSIONS
The use of absorbable surgical barrier film without sutures for colocolic anastomosis in rats may be safe.
Nejdet
Bildik
B
2nd Surgical Clinic Department of Pathology, Dr Lütfi Kırdar Kartal Training and Research Hospital Kartal, İstanbul, Turkey. nejdetbildik@gmail.com
Ayhan
Cevik
C
Doğan
Fakıoğlu
F
Mehmet
Altıntaş
A
Hüseyin
Ekinci
E
Gülay
Dalkılıç
D
Mustafa
Gülmen
G
Nagehan
Barışık
B
D000714:Anastomosis, Surgical / Q000295:instrumentation*; D057868:Anastomotic Leak / Q000517:prevention & control; D000818:Animals; D003106:Colon / Q000473:pathology / Q000601:surgery*; D005260:Female; D006909:Hydroxyproline / Q000032:analysis; D051381:Rats; D017208:Rats, Wistar
D006909:Hydroxyproline