title: Double 90 Degrees Counterrotated End-to-End-Anastomosis: An Experimental Study of an Intestinal Anastomosis Technique.
abstract: OBJECTIVE
  The aim of the article is to investigate a new anastomotic technique compared with standardized intestinal anastomotic procedures.
  
  
  METHODS
  A total of 32 male Wistar rats were randomized to three groups. In the Experimental Group (n = 10), the new double 90 degrees inversely rotated anastomosis was used, in the End Group (n = 10) a single-layer end-to-end anastomosis, and in the Side Group (n = 12) a single-layer side-to-side anastomosis. All anastomoses were done using interrupted sutures. On postoperative day 4, rats were relaparotomized. Bursting pressure, hydroxyproline concentration, a semiquantitative adhesion score and two histological anastomotic healing scores (mucosal healing according to Chiu and overall anastomotic healing according to Verhofstad) were collected. Most data are presented as median (range). p < 0.05 was considered significant.
  
  
  RESULTS
  Anastomotic insufficiency occurred only in one rat of the Side Group. Median bursting pressure in the Experimental Group was 105 mm Hg (range = 72-161 mm Hg), significantly higher in the End Group (164 mm Hg; range = 99-210 mm Hg; p = 0.021) and lower in the Side Group by trend (81 mm Hg; range = 59-122 mm Hg; p = 0.093). Hydroxyproline concentration did not differ significantly in between the groups. The adhesion score was 2.5 (range = 1-3) in the Experimental Group, 2 (range = 1-2) in the End Group, but there were significantly more adhesions in the Side Group (range = 3-4); p = 0.020 versus Experimental Group, p < 0.001 versus End Group. The Chiu Score showed the worst mucosal healing in the Experimental Group. The overall Verhofstad Score was significantly worse (mean = 2.032; standard deviation [SD] = 0.842) p = 0.031 and p = 0.002 in the Experimental Group, compared with the Side Group (mean = 1.729; SD = 0.682) and the End Group (mean = 1.571; SD = 0.612).
  
  
  CONCLUSIONS
  The new anastomotic technique is feasible and did not show any relevant complication. Even though it was superior to the side-to-side anastomosis by trend with respect to functional stability, mucosal healing surprisingly showed the worst results. Classical end-to-end anastomosis still seems to be the best choice regarding structural and functional anastomotic stability.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Holzner
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Seifert
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Torben
authors.initials: T
authors.lastname: Glatz
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Sophia
authors.initials: S
authors.lastname: Chikhladze
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Höppner
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hopt
authors.affiliation: Department of Pathology, Institute for Pathology, Freiburg, Germany.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Timme
authors.affiliation: Department of Pathology, Institute for Pathology, Freiburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Bronsert
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Olivia
authors.initials: O
authors.lastname: Sick
authors.affiliation: Department of Minimally Invasive Surgery, Wuhan No. 1 Hospital, Wuhan, Hubei Province, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
authors.forename: Goran
authors.initials: G
authors.lastname: Marjanovic
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D000818:Animals; D005240:Feasibility Studies; D006909:Hydroxyproline / Q000378:metabolism; D007413:Intestinal Mucosa / Q000502:physiology; D007422:Intestines / Q000473:pathology / Q000502:physiology / Q000601:surgery*; D008297:Male; D011897:Random Allocation; D017208:Rats, Wistar; D013536:Suture Techniques; D013718:Tensile Strength; D000267:Tissue Adhesions / Q000473:pathology; D014945:Wound Healing
chemical_list: D006909:Hydroxyproline