title: Intestinal Intramural Vascular Anastomoses.
abstract: BACKGROUND
  Present surgical techniques are rarely relying on intestinal intramural vascular anastomoses; however, this could open new limits in reconstructive surgery. Our aim was to study the efficacy of the antimesenteric and the longitudinal intramural vascular anastomoses in a porcine model.
  
  
  METHODS
  Five minipigs were used. Antimesenteric anastomoses: jejunal loops were detubularized by cutting along the antimesenteric line (Control), in the middle between the mesenteric and antimesenteric border (Group 1) and close to the mesenteric line (Group 2). Mucosal microcirculation (red blood cell velocity, perfusion rate) was recorded with orthogonal polarization spectral imaging (Cytoscan A/R) at the long edge of the detubularized bowel. Longitudinal anastomoses: records were made on a continuous jejunal loop following antimesenteric incision, detubularization, and subsequent ligation of 2, 4, and 6 neighboring vasa recta in the middle of the loop. The same study was repeated on the free end of completely divided jejunal segments with ligation of 2, 4, or 6 vasa recta.
  
  
  RESULTS
  Antimesenteric anastomoses: There was no statistically significant difference in red blood cell velocity and perfusion rate between Control and Groups 1 and 2. Longitudinal anastomoses: The red blood cell velocity dropped significantly, while the perfusion rate did not change significantly after ligation of 4 vasa recta in the continuous loop. In the loop with a free end, however, both parameters decreased significantly after ligation of four vessels.
  
  
  CONCLUSIONS
  It is safe to rely on antimesenteric intramural anastomoses but strong limitation of longitudinal intramural vascular anastomoses should be considered in intestinal reconstructions.
authors.affiliation: a Department of Paediatric Urology , Royal Manchester Children's University Hospital , Manchester , United Kingdom.|b Institute of Surgical Research , University of Szeged , Szeged , Hungary.
authors.forename: Raimondo M
authors.initials: RM
authors.lastname: Cervellione
authors.affiliation: b Institute of Surgical Research , University of Szeged , Szeged , Hungary.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Varga
authors.affiliation: b Institute of Surgical Research , University of Szeged , Szeged , Hungary.
authors.forename: Daniel
authors.initials: D
authors.lastname: Hajnal
authors.affiliation: b Institute of Surgical Research , University of Szeged , Szeged , Hungary.
authors.forename: Daniel
authors.initials: D
authors.lastname: Erces
authors.affiliation: b Institute of Surgical Research , University of Szeged , Szeged , Hungary.
authors.forename: Jozsef
authors.initials: J
authors.lastname: Kaszaki
authors.affiliation: c Department of Paediatric Surgery , Royal Manchester Children's University Hospital , Manchester , United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Harwood
authors.affiliation: c Department of Paediatric Surgery , Royal Manchester Children's University Hospital , Manchester , United Kingdom.
authors.forename: George
authors.initials: G
authors.lastname: Rakoczy
authors.affiliation: a Department of Paediatric Urology , Royal Manchester Children's University Hospital , Manchester , United Kingdom.|b Institute of Surgical Research , University of Szeged , Szeged , Hungary.
authors.forename: Tamas
authors.initials: T
authors.lastname: Cserni
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D007413:Intestinal Mucosa / Q000098:blood supply* / Q000000981:diagnostic imaging; D007583:Jejunum / Q000098:blood supply* / Q000601:surgery*; D008638:Mesenteric Arteries / Q000601:surgery*; D008833:Microcirculation; D013552:Swine; D013556:Swine, Miniature
keywords: intestine; intramural blood supply; orthogonal spectral imaging; pig