Colorectal anastomosis facilitated by the use of the LigaSure(®) sealing device: comparative study in an animal model.
BACKGROUND
Recently, there has been speculation about the possibility of fusing intestinal tissue using bipolar sealing devices. In this study we compare in a porcine model the anastomoses created using the LigaSure(®) device with those created with a stapler after section and closure of a rectal stump.


METHODS
Thirty pigs underwent laparoscopic colorectal anastomosis. In group A (n = 15), the division of the intestine and distal stump closure were done with a 10-mm LigaSure Atlas(®) device. In group B, these steps were carried out using an endoscopic stapler. Subsequently, the colorectal anastomosis was performed using circular stapling in both groups. The 4-week follow-up included health status, weight gain, blood tests, X-rays, and colonoscopy. Anastomotic tissue was processed to study the mechanical tensile strength and histopathology.


RESULTS
There was no difference in the rate of conversion to open surgery or in average operating time between the groups. In the sealing device group, there was a significantly higher rate of failure in rectal stump closure (p = 0.042). There was one death in group B due to anastomotic leak. There was no difference in adhesion formation or stenosis. Mid-section anastomosis area was 89.7 mm(2) in group A compared with 100 mm(2) in group B (p = 0.52). In tensile strength studies, the maximum load resisted by the sample was 13.8 ± 4.9 N (group A) versus 15.7 ± 4.4 N (group B) (p = 0.17). There was no difference between the groups in degree of reepithelialization, number of inflammatory cells, or the presence of microabscesses.


CONCLUSIONS
Division and sealing of the rectal stump with the LigaSure(®) device is feasible in the proposed experimental model, but it is less reliable than conventional closure with a stapler, since it has a significantly greater failure rate. Therefore, The LigaSure(®) device should not be used for this purpose in the clinical setting as this could lead to serious and dramatic complications.
Department of Surgery, «La Mancha Centro» General Hospital, Avenida de la Constitución Nº. 3, Alcázar de San Juan, 13600, Ciudad Real, Spain, fsdepedro@gmail.com.
Francisco
F
Sánchez-De Pedro
Carlos
C
Moreno-Sanz
Antonio
A
Morandeira-Rivas
Jose María
JM
Tenías-Burillo
Cristina
C
Alhambra-Rodríguez De Guzmán
D000714:Anastomosis, Surgical / Q000295:instrumentation; D057868:Anastomotic Leak / Q000517:prevention & control; D000818:Animals; D003106:Colon / Q000601:surgery*; D003108:Colonic Diseases / Q000601:surgery; D004195:Disease Models, Animal; D004867:Equipment Design; D005260:Female; D010535:Laparoscopy / Q000379:methods*; D012007:Rectum / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013552:Swine