Search

Optimizing the regeneration process of surgically created anastomoses (blood vessels, intestines, nerves) is an important topic in surgical research. One of the most interesting parameter groups is related to the biomechanical properties of the anastomoses. Depending on the regeneration process and its influencing factors, tensile strength and other biomechanical features may change during the healing process. Related to the optimal specimen size, the range and accuracy of measurements, and applicability, we have developed a custom-tailored microcontroller-based device. In this paper, we describe the hardware and software configuration of the latest version of the device, including experiences and comparative measurements of tensile strength and elasticity of artificial materials and biopreparate tissue samples. The machine we developed was made up of easily obtainable parts and can be easily reproduced on a low budget. The basic device can apply a force of up to 40 newtons, and can grasp a 0.05–1 cm wide, 0.05–1 cm thick tissue. The length of the test piece on the rail should be between 0.3 and 5 cm. Low production cost, ease of use, and detailed data recording make it a useful tool for experimental surgical research. [ABSTRACT FROM AUTHOR]

Background: Intestinal anastomosis is a fundamental surgical procedure performed in various gastrointestinal surgeries, where two ends of the intestine are joined together after a resection. Aim: To compare the effectiveness of single-layered and double-layered intestinal anastomosis. Materials and Methods: A prospective, single-centre, double-blind, randomized controlled study was conducted within the Department of General Surgery to compare the outcomes of two different techniques for intestinal resection and anastomosis. The study included both emergency and elective procedures involving jejuno-jejunal, jejuno-ileal, ileo-ileal, ileo-colic, and colo-colic anastomoses, as well as stoma closures. A total of 100 eligible patients who underwent intestinal resection and anastomosis were randomly assigned to one of two groups. The participants were then randomly allocated to undergo either a single-layer extramucosal intestinal anastomosis (Group A) or a double-layer intestinal anastomosis (Group B). Results: The duration for which the nasogastric tube remained in place was shorter in Group A (2.3 ± 0.7 days) compared to Group B (3.1 ± 0.8 days), with a p-value of <0.001. The time for the return of bowel sounds postoperatively was also faster in Group A (2.5 ± 0.6 days) compared to Group B (3.4 ± 0.9 days), with a p-value of <0.001. Similarly, the first postoperative bowel movement occurred earlier in Group A (3.1 ± 0.8 days) than in Group B (4.2 ± 1.0 days), with a p-value of <0.001. On average, patients in Group A were discharged after 7.8 ± 1.4 days, whereas those in Group B required 10.2 ± 1.6 days of hospitalization (p<0.001). Conclusion: We concluded that the single-layer anastomosis technique is superior to the double-layer technique in terms of operative time, suture material usage, and cost efficiency, without compromising patient safety. [ABSTRACT FROM AUTHOR]

The article discusses the problem of colonic anastomotic leakage in patients who underwent resection for colorectal cancer. We describe risk factors for colonic anastomotic leakage and diagnostic approaches. Particular attention is given to noninvasive early diagnosis of anastomotic leakage using laboratory tests with specific biochemical markers.

Hemorheological factors may show arterio-venous differences. Alterations in acid-base and metabolic parameters may also influence these factors. However, little is known about changes in micro-rheological parameters during abdominal surgery, influencing splanchnic circulation. In anesthetized pigs, the external jugular vein, femoral artery and vein were cannulated unilaterally, and paramedian laparotomy was performed. In the anastomosis group, after resecting a bowel segment, end-to-end jejuno-jejunostomy was completed. Blood samples (from cannulas and by puncturing the portal vein) were taken before and after the intervention. Hematological, acid-base and blood gas parameters, metabolites, red blood cell (RBC) deformability and aggregation were determined. The highest hematocrit was found in portal blood, increasing further by the end of operation. A significant pH decrease was seen, and portal blood showed the highest lactate and creatinine concentration. The highest RBC aggregation values were found in arterial, the lowest in renal venous blood. The RBC aggregation increased with higher lactate concentration and lower pH. Osmotic gradient deformability declined, with the lowest values in portal and renal venous samples. In conclusion, micro-rheological parameters showed arterio-venous and porto-renal venous differences, influenced by oxygenation level, pH and lactate concentration. The intestinal anastomosis operation caused an immediate micro-rheological deterioration with portal venous dominancy in this experiment. [ABSTRACT FROM AUTHOR]

Introduction: Anastomotic leak (AF) is a surgical complication, with an incidence of 2-14% and a mortality rate of 5-22%. The diagnosis is based on clinical and radiological criteria; it is associated with re-interventions, longer hospital stay and costs. Aim: To evaluate the use of C-reactive protein (CRP) and procalcitonin (PCT) as early predictors of anastomotic leak (AL) in elective colon surgery. Material and Method Prospective observational study. 107 patients who underwent a partial colectomy for cancer with elective primary anastomosis in the Hospital Hernán Henríquez Aravena surgery unit in Temuco from April 2019 to April 2022. CRP and PCT were measured in all patients in the first 4 postoperative days. The primary measurement outcome was to determine the sensitivity, specificity, and negative predictive value (NPV) of CRP and PCT for AF. Results: 7.4% of the total presented AL. The PCT and CRP values were high in all the patients tending to normalization on the fourth postoperative day, except in the presence of a postoperative complication. The ROC curve analysis showed an area under the curve of 93% and 75% for CRP and PCT respectively on the third postoperative day, with this being the best combination. Conclusion Both PCT and CRP are useful predictors of AL, with a high NPV on the third postoperative day. These precede the clinic and require an imaging study to confirm the diagnosis and act immediately to reduce the morbidity and mortality associated with this complication. [ABSTRACT FROM AUTHOR]

Background: The use of high-frequency electric welding technology for intestinal end-to-end anastomosis holds significant promise. Past studies have focused on in vitro, and the safety and efficacy of this technology is uncertain, severely limiting the clinical application of this technology. This study investigates the impact of compression pressure, energy dosage, and duration on anastomotic quality using a homemade anastomosis device in both in vitro and in vivo settings. Methods: Two hundred eighty intestines and 5 experimental pigs were used for in vitro and in vivo experiments, respectively. The in vitro experiments were conducted to study the effects of initial pressure (50–400 kpa), voltage (40–60 V), and time (10–20 s) on burst pressure, breaking strength, thermal damage, and histopathological microstructure of the anastomosis. Optimal parameters were then inlaid into a homemade anastomosis and used for in vivo experiments to study the postoperative porcine survival rate and the pathological structure of the tissues at the anastomosis and the characteristics of the collagen fibers. Results: The anastomotic strength was highest when the compression pressure was 250 kPa, the voltage was 60 V, and the time was 15 s. The degree of thermal damage to the surrounding tissues was the lowest. The experimental pigs had no adverse reactions after the operation, and the survival rate was 100%. 30 days after the operation, the surgical site healed well, and the tissues at the anastomosis changed from immediate adhesions to permanent connections. Conclusion: High-frequency electric welding technology has a certain degree of safety and effectiveness. It has the potential to replace the stapler anastomosis in future and become the next generation of new anastomosis device. [ABSTRACT FROM AUTHOR]

Negative pressure wound therapy (NPWT) is part of the temporary abdominal closure in the treatment of patients with traumatic, inflammatory, or vascular disease. However, the use of NPWT when performing an intestinal anastomosis has been controversial. This study aimed to describe the patients managed with NPWT therapy and identify the risk factors for anastomotic dehiscence when intestinal anastomosis was performed. A single-center cohort study with prospectively collected databases was performed. Patients who required NPWT therapy from January 2014 to December 2018 were included. Patients were stratified according to the performance of intestinal anastomosis and according to the presence of dehiscence. Bivariate and multivariate analyses were performed for anastomotic dehiscence and mortality. A total of 97 patients were included. Median age was 52 y old [interquartile range 24.5-70]. Male patients corresponded to 75.6% (n = 34) of the population. Delayed fascial closure was performed in 80% (n = 36). The risk of anastomotic dehiscence was higher in females (odds ratio (OR) 11.52 [confidence interval (CI) 1.29-97.85], P = 0.030), delayed fascial closure (OR 18.18 [CI 2.02-163.5], P = 0.010) and use of vasopressors (OR 12.04 [CI 1.22-118.47], P = 0.033). NPWT pressures >110 mmHg were evidenced in the dehiscence group with statistically significant value (OR 1.2 [0.99-2.26] p 0.04) There is still controversy in the use of NPWT when performing intestinal anastomosis. According to our data, the risk of dehiscence is higher in females, delayed fascial closure, use of vasopressors, and NPWT pressures >110 MMHG. [ABSTRACT FROM AUTHOR]

Keeping children nil by mouth until return of bowel function after intestinal anastomosis surgery is said to reduce complications. Fasting may extend up to five days, risking malnourishment and usage of parenteral nutrition. This study aims to establish the efficacy and safety of early enteral nutrition in children undergoing intestinal stoma closure. A retrospective cohort study of children aged three months to 16 years who underwent an intestinal stoma closure between 1/1/2019 and 31/12/2021 at two tertiary paediatric hospitals was undertaken. Children fed clear fluids within 24 h (EEN) were compared to those commencing feeds later (LEN). The primary outcome was length of post-operative stay (LOS) and secondary outcomes included: time to feeds; time to stool; and complications. Of the 129 children that underwent a stoma closure, 69 met inclusion criteria: 35 (51 %) in the LEN group and 34 (49 %) in the EEN group. Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h, p = 0.0045). Early feeding was also associated with a significantly decreased time to free fluids (p < 0.001) and full enteral intake (p = 0.007). There was no significant intergroup difference in complications. Commencing feeding within 24 h of stoma closure is efficacious and safe, with clear reductions in LOS, time to full feeds and time to stool, and no increase in complications. Further research is required to extrapolate these findings to other populations. III. • What is currently known about this topic? Early enteral nutrition may decrease time to feeds and length of hospitalisation. However, most publications to date contain a diverse range of surgical conditions and operations, making results difficult to interpret. There is also concern that early feeding may increase complications, notably the incidence of post-operative anastomotic leak. • What new information is contained in the article? Early enteral nutrition is efficacious and safe for children undergoing intestinal anastomosis following stoma closure. It is associated with shorter length of stay, time to free fluids and time to full enteral intake, without increasing complication rates. [ABSTRACT FROM AUTHOR]

Optimizing the regeneration process of surgically created anastomoses (blood vessels, intestines, nerves) is an important topic in surgical research. One of the most interesting parameter groups is related to the biomechanical properties of the anastomoses. Depending on the regeneration process and its influencing factors, tensile strength and other biomechanical features may change during the healing process. Related to the optimal specimen size, the range and accuracy of measurements, and applicability, we have developed a custom-tailored microcontroller-based device. In this paper, we describe the hardware and software configuration of the latest version of the device, including experiences and comparative measurements of tensile strength and elasticity of artificial materials and biopreparate tissue samples. The machine we developed was made up of easily obtainable parts and can be easily reproduced on a low budget. The basic device can apply a force of up to 40 newtons, and can grasp a 0.05–1 cm wide, 0.05–1 cm thick tissue. The length of the test piece on the rail should be between 0.3 and 5 cm. Low production cost, ease of use, and detailed data recording make it a useful tool for experimental surgical research.

To investigate the influence of anastomosis on the early postoperative and long-term oncological outcomes of patients with primary colon carcinoma (CA).

Hemorheological factors may show arterio-venous differences. Alterations in acid-base and metabolic parameters may also influence these factors. However, little is known about changes in micro-rheological parameters during abdominal surgery, influencing splanchnic circulation. In anesthetized pigs, the external jugular vein, femoral artery and vein were cannulated unilaterally, and paramedian laparotomy was performed. In the anastomosis group, after resecting a bowel segment, end-to-end jejuno-jejunostomy was completed. Blood samples (from cannulas and by puncturing the portal vein) were taken before and after the intervention. Hematological, acid-base and blood gas parameters, metabolites, red blood cell (RBC) deformability and aggregation were determined. The highest hematocrit was found in portal blood, increasing further by the end of operation. A significant pH decrease was seen, and portal blood showed the highest lactate and creatinine concentration. The highest RBC aggregation values were found in arterial, the lowest in renal venous blood. The RBC aggregation increased with higher lactate concentration and lower pH. Osmotic gradient deformability declined, with the lowest values in portal and renal venous samples. In conclusion, micro-rheological parameters showed arterio-venous and porto-renal venous differences, influenced by oxygenation level, pH and lactate concentration. The intestinal anastomosis operation caused an immediate micro-rheological deterioration with portal venous dominancy in this experiment.

Preventing anastomotic leakage (AL) and postoperative adhesions after gastrointestinal surgery is crucial for ensuring a favorable surgical prognosis. However, AL prevention using tissue adhesives can unintentionally lead to undesirable adhesion formation, while anti-adhesive agents may interfere with wound healing and contribute to AL. In this study, we have developed a double-layer patch, consisting of an adhesive layer on one side, utilizing gallic acid-conjugated chitosan (CHI-G), and an anti-adhesive layer on the opposite side, employing crosslinked hyaluronic acid (cHA). These CHI-G/cHA double-layer adhesives significantly prevented AL by forming physical barriers of CHI-G and reduced post-surgical adhesion at the anastomosis sites by the anti-adhesive layers of cHA. The bursting pressure (161.1 ± 21.6 mmHg) of double-layer adhesives-applied rat intestine at postoperative day 21 was far higher than those of the control (129.4 ± 5.7 mmHg) and the commercial anti-adhesives-applied group (120.8 ± 5.2 mmHg). In addition, adhesion score of double-layer adhesives-applied rat intestine was 3.6 ± 0.3 at postoperative day 21, which was similar to that of the commercial anti-adhesives-applied group (3.6 ± 0.3) and lower than that of the control group (4.9 ± 0.5). These findings indicate that the double-layer patch (CHI-G/cHA) has the potential to effectively prevent both postoperative adhesions and anastomotic leakage, offering a promising solution for gastrointestinal surgery.

Background and Aims: Intestinal anastomosis is a clinical procedure widely used to reconstruct the digestive tract, but authentic laparoscopic intracorporeal intestinal anastomosis (LIIA) models are lacking. However, three-dimensional (3D) printing can enable authentic and reusable models. In this paper, a novel cost-effective 3D-printing training model of LIIA is designed and the authenticity and validity of the model are tested. Methods: A fused deposition modeling 3D printing and an assembled lab model were built to test LIIA. Fifteen surgeons were required to perform LIIA, and their operation score and time were recorded and analyzed. Five experts were invited to assess the face and content validity of the models. A study was also performed to further evaluate and validate the learning curve of surgeons. Results: The difference in modified anastomosis objective structured assessment of technical skills (MAOSATS) scores between the expert, intermediate, and novice groups were significant (64.1±1.8: 48.5±1.7: 29.5±3.1, P<0.001). In addition, the operation time of the procedure was statistically different for all three groups (21.5±1.9: 30.6±2.8:70.7±4.0, P<0.001). The five experts rated the face and content validity of the model very highly, with the median being four out of five. Surgeons who underwent repeated training programs showed improved surgical performance. After eight training sessions, the novices' performance was similar to that of the average level of untrained intermediates, while the operation scores of the intermediates were close to that of the average level of experts. Conclusions: In this study, it is found that the LIIA model exhibits excellent face, content, and construct validity. Repeated simulation training of the LIIA training program improved the surgeon's operative performance, so the model is considered one of the most effective methods for LIIA training and assessment of surgical quality in the future and for reducing healthcare costs. [ABSTRACT FROM AUTHOR]

Background: Conventionally, oral feeds after distal bowel anastomosis surgery (ileostomy/colostomy closure) are delayed until after bowel peristalsis is established. The safety of an early feeding regimen is not established in children. This study compared early feeding regimens with delayed feeding in children undergoing elective intestinal anastomosis surgeries. Materials and Methods: In this retrospective multicentric cohort study, children undergoing elective distal bowel anastomosis surgery were divided into Group A (oral feeds allowed within 6 h) and Group B (delayed feeds). The two groups were compared for the incidence of abdomen distension, vomiting, surgical site infection, duration of analgesia, length of hospital stay, and readmission rate. Results: During the study, 58 patients were included: Group A (n = 26) and Group B (n = 32). The duration of analgesia (1.9 vs. 4.01 days) and length of hospital stay (3.38 vs. 5.0 days) were significantly less in Group A. Abdominal distension (7.7% vs. 15.6%), vomiting (11.5% vs. 15.6%), surgical site infection rate (3.8% vs. 12.5%), and readmissions (0% vs. 3.1%) were less in Group A, but statistically not significant. Conclusion: Early feeding after the elective restoration of distal bowel continuity can be safely practiced in the pediatric population. It is associated with a reduced need for analgesia and shorter hospital stay. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing resection anastomoses for various causes like bowel obstruction, incarcerated hernias, benign and malignant tumors of small and large bowel is not so uncommon. This comparative study endeavours to compare outcome of single layer versus double layer intestinal anastomosis in small and large bowel in terms of duration required to perform intestinal anastomosis, post operative complications like anastomotic leak, duration of hospital stay in each group. Materials & Methods: The patients selected for this study are those who were admitted with various clinical conditions requiring resection and anastomosis of small and large bowel. Results: The maximum number of patients in group A (single layer) were in the age group of 31-40 years i.e. 08 (32%) and in group B (double layer) maximum number of patients were in the age group of 41-50 years i.e. 09 (36%). In group A (single layer) there were 17 (68%) males and 08 (32%) females. In group B (Double layer) there were 15 (60%) males and 10 (40%) females. In our study of fifty cases in both groups terminal ileal stricture was diagnosed in maximum number of patients i.e. 13 (26%) cases. In our study of fifty cases in both groups, resection of terminal ileum and ileoileal anastomosis was performed in maximum number of patients i.e. 21 (42%) cases. Three different types of anastomosis all together in both groups depending up on the position of the viscera. In both the groups end to end type of anastomosis was done in all of the cases, i.e. in group A (single layer) 25 (100%) patients and in group B(double layer) 25(100%) patients. No side to side type of anastomosis or end to side anastomosis was performed in either of groups Conclusion: Duration required to perform a single layer intestinal anastomosis is significantly lesser when compared to double layer. [ABSTRACT FROM AUTHOR]

Background: Conventionally, oral feeds after distal bowel anastomosis surgery (ileostomy/colostomy closure) are delayed until after bowel peristalsis is established. The safety of an early feeding regimen is not established in children. This study compared early feeding regimens with delayed feeding in children undergoing elective intestinal anastomosis surgeries. Materials and Methods: In this retrospective multicentric cohort study, children undergoing elective distal bowel anastomosis surgery were divided into Group A (oral feeds allowed within 6 h) and Group B (delayed feeds). The two groups were compared for the incidence of abdomen distension, vomiting, surgical site infection, duration of analgesia, length of hospital stay, and readmission rate. Results: During the study, 58 patients were included: Group A (n = 26) and Group B (n = 32). The duration of analgesia (1.9 vs. 4.01 days) and length of hospital stay (3.38 vs. 5.0 days) were significantly less in Group A. Abdominal distension (7.7% vs. 15.6%), vomiting (11.5% vs. 15.6%), surgical site infection rate (3.8% vs. 12.5%), and readmissions (0% vs. 3.1%) were less in Group A, but statistically not significant. Conclusion: Early feeding after the elective restoration of distal bowel continuity can be safely practiced in the pediatric population. It is associated with a reduced need for analgesia and shorter hospital stay.

BackgroundTo prevent postoperative complications, delayed oral feeding (DOF) remains a common model of care following pediatric intestinal anastomosis surgery; however, early oral feeding (EOF) has been shown to be safe and effective in reducing the incidence of complications and fast recovery after pediatric surgery. Unfortunately, the evidence in support of EOF after intestinal anastomosis (IA) in infants is insufficient. Therefore, this study was primarily designed to evaluate the safety and efficacy of EOF. In addition, the current status of EOF application and associated factors that favor or deter EOF implementation were also assessed.MethodsA total of 898 infants were divided into two groups (EOF group, n = 182; DOF group, n = 716), and the clinical characteristics were collected to identify the factors associated with EOF in infants. Complications and recovery were also compared to define the safety and efficacy after balancing the baseline data by propensity score matching (PSM) (EOF group, n = 179; DOF group, n = 319).ResultsThe total EOF rate in infants with IA was 20.3%. Multivariate logistic regression revealed significant differences in the EOF rates based on IA site and weight at the time of surgery (OR = 0.652, 95% CI: 0.542–0.784, p 0.05).ConclusionThe overall rate of EOF in infants following IA was low, and the sites of anastomosis and weight at surgery were two factors associated with EOF. Nevertheless, performing EOF in infants after IA was safe and effective, reduced PN usage, shortened the hospital stay, and did not increase the rate of severe complications.Clinical Trial Registration: ClinicalTrails.gov, identifier NCT04464057.

Intestinal suture dehiscence is one of the most feared complications following gastrointestinal surgery in both human and veterinary medicine, increasing the morbidity and mortality of these patients. Clinical and laboratory early signs of septic peritonitis are not always easily identifiable while prompt treatment should help decrease postoperative morbidity and mortality. The aim of this study is to describe the ultrasonographic (US) features of confirmed leakage of intestinal sutures (LIS) and to evaluate if this imaging technique can be useful as noninvasive tool for the early diagnosis of LIS. Seven dogs developed LIS in a range of three-four days after gastrointestinal surgery and four of these developed a second dehiscence. On B-mode ultrasonography, all intestinal surgical sites were identified and characterized by a bowel focal thickening with reduced or absent wall layering and the presence of hyperechoic, double-walled foci at regular intervals (suture material). Furthermore, hyperechoic linear interfaces associated with dirty acoustic shadowing and comet-tail artifacts crossing the intestinal wall to free-float in peritoneal cavity or in a saccate collection have been documented. On the basis of these preliminary results, canine abdominal ultrasound seems to be a useful diagnostic technique for post-operative monitoring of patients undergoing intestinal surgery, allowing early detection of signs of a LIS, before the patient develops clinical signs of septic peritonitis.

Background: Intestinal resection is a lifesaving procedure, one of the two options following resection is anastomosis which carries the best opportunity for the patient and his quality of life. However, A set of complications mainly leakage may follow with a variety of consequences that may threaten patient's life. Strong efforts are being made to avoid anastomosis leak through avoiding factors which may increase incidence of leak and finding additional factors to promote anastomotic healing. The pedicled omental transposition (omentoplasty) for reinforcing the anastomotic suture line is tested regarding the incidence of leakage after intestinal resection. Methods: A prospective comparative study has been conducted on patients who have performed gastrointestinal surgery at Kasr El Ainy hospital from 2021 to 2022. Patients have been divided into 2 groups. The first group included patients who had undergone omental wrap around anastomosis [group A] [n=32] and the other group included patients who didn't go through omental wrap around anastomosis [group B] [n=32]. Age range for both groups ranged from 18 to 73 years [mean 44.5 years]. Data analysis performed using SPSS statistical package. Results: Results revealed presence of statistically significant decrease in complication associated with anastomosis between the group undergone omental wrapping and the group undergone anastomosis without omental wrapping in favour of omental wrapping [P-value =0.047]. Conclusions: Anastomotic leakage is an expected complication after gastrointestinal anastomosis. Omental wrap proved to be a technique that enhances decreasing the post anastomosis leakage after gastrointestinal anastomosis. [ABSTRACT FROM AUTHOR]

Background Anastomosis near the ileocecal valve (ICV) are controversial due to the increased pressure on the suture; in this situation, the valve could be removed at a first stage or at the moment of stoma closure. However, preservation of the ICV has proved important benefits in the long term. The aim of this study is to evaluate its feasibility in neonates with focal intestinal perforation (FIP). Methods Retrospective study (2010–2019) of neonates with FIP who underwent intestinal resection and primary anastomosis. Patients were divided into group A (anastomosis less than 5 cm from ICV) and group B (more than 5 cm). Results Forty patients were treated. Patients ostomized or with resection of ICV were excluded. Finally, 24 patients (birth weight 1043 ± 594 g (520–3000), age 8.8 ± 7.8 days (2–39)) were included for analysis. Patent ductus arteriosus was present in 75%. There were 6 patients in group A (25%) and 18 in group B (75%). Groups were comparable in terms of gestational age, birth weight, and age at the time of surgery (p > .05). There were no cases of dehiscence nor stenosis of the anastomosis. There were no differences in reoperation rate, infectious complications, time to enteral feeding, days of parenteral nutrition, hospital stay nor survival (p > .05). Conclusion Ileo-ileal anastomosis closer to the ileocecal junction, in neonates with focal intestinal perforation, is an effective and safe option which also allows the preservation of the ICV avoiding the complications derived from its absence in a group of patients with high morbidity. [ABSTRACT FROM AUTHOR]

In the present study, the effect of autogenous peritoneum graft (PG) with platelet rich fibrin (PRF) was evaluated on intestinal anastomosis healing in dogs. Eighteen local breed adult dogs were anesthetized then jejunal intestinal resection and anastomosis were created on all animals. Animals were divided into 3 equal groups (6 for each). In first group (control): An end-to-end intestinal anastomosis was performed using simple interrupted suture pattern only. In group PG: The anastomosis site was sutured as in control group and was wrapped with PG. Where as in PRF+PG group: The anastomosis site was sutured also as in first group and was wrapped with PRF and PG. Healing process was studied in all above mentioned groups clinically, grossly, histologically and radiographically at 15 and 30 days post operation. Results were revealed that the utilizing of PG caused a valuable influence on anastomosis site healing. This impact was manifested by faster re-epithelization of mucosa, increased collagen deposition, fibroblast proliferation, reduced adhesions, and decreased stenosis degree comparison with control group. Also there was less adhesions, less stenosis degree, increased in epithelization of the mucosa in the group treated with PRF+PG than the group treated with PG alone. In conclusion the current study has shown that autologous peritoneal graft application has a positive and beneficial effect on intestinal anastomosis healing. Also the results highlighted the promising effects of PRF in conjunction with PG on intestinal anastomosis healing. The application of PRF with PG at the intestinal anastomosis site is successful, safe, and highly efficient with no complications.

BackgroundAnastomotic leakage is a life-threatening complication. Improvement of the anastomosis technique is needed, especially in patients with an inflamed edematous intestine. The aim of our study was to evaluate the safety and efficacy of an asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis in pediatric patients.MethodsA total of 23 patients underwent intestinal anastomosis at the Department of Pediatric Surgery of Binzhou Medical University Hospital. Demographic characteristics, laboratory parameters, anastomosis time, duration of nasogastric tube placement, day of first postoperative bowel movement, complications, and length of hospital stay were statistically analyzed. The follow-up was conducted for 3–6 months after discharge.ResultsPatients were divided into two groups: the single-layer asymmetric figure-of-eight suture technique (group 1) and the traditional suture technique (group 2). Body mass index in group 1 was lower than in group 2 (14.43 ± 3.23 vs. 19.38 ± 6.74; P = 0.036). The mean intestine anastomosis time in group 1 (18.83 ± 0.83 min) was less than that in group 2 (22.70 ± 4.11 min; P = 0.005). Patients in group 1 had an earlier first postoperative bowel movement (2.17 ± 0.72 vs. 2.80 ± 0.42; P = 0.023). The duration of nasogastric tube placement in group 1 was shorter than that in group 2 (4.12 ± 1.42 vs. 5.60 ± 1.57; P = 0.043). There was no significant difference in laboratory variables, complication occurrence, and length of hospital stay between the two groups.ConclusionThe asymmetric figure-of-eight single-layer suture technique for intestinal anastomosis was feasible and effective. More studies are needed to compare the novel technique with the traditional single-layer suture.

Background: The intestinal anastomosis is a surgical procedure to restore intestinal continuity, one of the most commonly performed surgical procedures for benign or malignant lesions of the gastrointestinal tract. The present study aimed to compare single-layer extra mucosal versus conventional double-layer anastomosis of intestines in elective and emergency laparotomy at a tertiary hospital. Material and Methods:This study was a prospective, comparative, interventional conducted in patients19-60 years of age who underwent resection and anastomosis of the small or large intestine for various indications either in elective or emergency laparotomy, willing to participate in the study. Results:82 patients underwent extra-mucosal single-layer anastomosis (group A, n=41) and the other with conventional double-layer anastomosis (group B, n=41). Less length of suture used (21.44 ± 7.75 cms vs. 40.27 ± 11.02 cms) & less time taken for anastomosis (20.37 ± 5.81 minutes vs. 34.64 ± 6.45 minutes) in extra-mucosal single-layer anastomosis as compared to conventional double layer anastomosis & difference was statistically significant (p<0.001). Other factors such as the return of bowel sounds (days), resuming flatus (days), the day on which oral intake >1 liter, drain removal (days), postoperative hospital stay (days) &ICU days were comparable in a single layer &double layer groups, the difference was not significant statistically. Postoperative Complications were common in the doublelayer group (3 cases of Anastomotic leak, two patients required re-intervention, three instances of Surgical site infection & 1 Mortality) as compared to the single-layer group (1 case of Anastomotic leak, one patient required re-interventions, two instances of Surgical site infection & 1 Mortality). The difference was not significant statistically. Conclusion:Considering the duration of the anastomosis procedure and medical expenses, the single-layer intestinal anastomosis may prove the choice of procedure for most surgeons. [ABSTRACT FROM AUTHOR]

Background: Intestinal anastomosis is one of the most common surgical procedure, required in the patients suffering with intestinal malignancy, inflammation, non-traumatic perforation, obstruction, etc. The present study assessed the efficacy and safety of the single layered anastomosis against the double-layered anastomosis after intestinal resection at a tertiary hospital. Material and Methods: Present study was single-center, prospective, comparative study, conducted in patients of either gender, >18 years of age, required emergency resection and anastomosis of small intestine. Results: In present study, 72 patients were divided as Group S (single layered anastomosis) and Group D (double layered anastomosis), 36 patients in each group. Both groups were comparable in terms of age, gender, co-morbidities & primary diagnosis, difference was not significant statistically (p> 0.05). Common procedures among both groups were Resection and ileo-ileal anastomosis (44.44% vs 47.22%) & Resection and jejuno-ileal anastomosis (22.22% vs 19.44%). Surgical procedures were comparable among both groups, difference was not significant statistically. Anastomosis time was comparatively lesser in single layer group as compared to double layer group (13.41 ± 4.14 minutes vs 21.37 ± 6.38 minutes) & difference was significant statistically (< 0.001).Postoperative complications were less in single layer group (1 cases of Dehiscence of anastomosis leak & 3 cases of Infection of surgical wound) as compared to double layer group (1 cases of Dehiscence of anastomosis leak & 3 cases of Infection of surgical wound), difference was not significant statistically (p> 0.05). Conclusion: Single layer anastomosis is preferable, safe and economic technique in comparison to the conventional double layered anastomosis as single layer anastomosis required less time construct the anastomosis, less incidence of complication like anastomotic leak & overall less cost of surgery, [ABSTRACT FROM AUTHOR]

Purpose: Intestinal anastomosis is a crucial step in most intestinal resections, as anastomotic leakage is often associated with severe consequences for affected patients. There are especially two different techniques for hand-sewn intestinal anastomosis: the interrupted suture technique (IST) and the continuous suture technique (CST). This study investigated whether one of these two suture techniques is associated with a lower rate of anastomotic leakage. Methods: A retrospective review of 332 patients with Crohn's disease who received at least one hand-sewn colonic anastomosis at our institution from 2010 to 2020 was performed. Using propensity score matching 183 patients with IST were compared to 96 patients with CST in regard to the impact of the anastomotic technique on patient outcomes. Results: Overall anastomotic leakage rate was 5%. Leakage rate did not differ between the suture technique groups (IST: 6% vs. CST: 3%, p = 0.393). Multivariate analysis revealed the ASA score as only independent risk factor for anastomotic leakage (OR 5.3 (95% CI = 1.2–23.2), p = 0.026). Suture technique also showed no significant influence on morbidity and the re-surgery rate in multivariate analysis. Conclusion: Our data suggest that the chosen suture technique (interrupted vs. continuous) has no influence on postoperative outcome, especially on anastomotic leakage rate. This finding should be confirmed by a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Gastroduodenal bleeding is one of the most challenging issues in surgery nowadays. The crude mortality rate due to severe blood loss in gastrointestinal bleeding is very high. Therefore, the use of medications to prevent severe blood loss and protect cells from the harmful effects of hypoxia should be the focus of attention in these conditions. This experimental study was carried out to establish changes in blood parameters and humoral immunity in rats after intestinal anastomoses combined with acute blood loss after the application of catholyte and anolyte. The study included 45 male Wistar rats weighing 290-320 g that were divided equally (15 animals per group) into three groups of intact animals (group 1), animals exposed to the small bowel resection (1.5 cm) with the end-to-end anastomosis and simulated acute blood loss (group 2), and animals exposed to the small bowel resection with end-to-end anastomosis and simulated acute blood loss that were daily given catholyte in the postoperative period group (group 3). After the surgery, the rats were given a catholyte solution per os, and the operative wound was treated with an anolyte. The blood samples and the wall of the small intestine in the anastomotic zone were used as a biological substrate to study the effect of catholyte on changes in the body during the healing process. The experiment was conducted for 15 days, and the data were recorded in two intervals on the 5th and 15th days after starting the experiment. The analyzed materials evidenced that the use of catholyte and liquid with negative oxidoreduction potential (ORP) (minus 500-520 mV) resulted in positive changes in the blood cell count, humoral immunity, and phagocytic activity impaired after the small bowel resection and blood loss. The use of an anolyte disinfectant (liquid with positive ORP+710-770 mV) prevented bacterial contamination of the surgical wound. The obtained findings proved that the catholyte had a positive effect on humoral immunity and healing processes in the anastomotic zone. Furthermore, the anolyte prevented the development of purulent complications and inflammation in the area of the surgical wound, and therefore, promoted the healing processes.

Anastomotic techniques are of vital importance in restoring gastrointestinal continuity after resection. An alternative asymmetric figure-of-eight single-layer suture anastomotic technique was introduced and its effects were evaluated in an in vitro porcine model. Twelve 15-cm grossly healthy small intestine segments from a porcine cadaver were harvested and randomly divided into asymmetric figure-of-eight single-layer suture (figure-of-eight suture) and single-layer interrupted suture technique (interrupted suture) groups (n = 6 in each group). The anastomosed bowel was infused with methylene blue solution to test anastomotic leakage. Anastomosis construction time, leakage, and suture material cost were recorded and analyzed statistically using Fisher's exact test and Student's t-test. One anastomotic leakage occurred (16.67%) in the figure-of-eight suture group, and two (33.33%) in the interrupted suture group (p > 0.9999). The anastomosis construction time was relatively short in the figure-of-eight suture group, but the difference did not reach a statistically significant level between the two groups. The mean number of suture knots and the cost of suture material in the figure-of-eight suture group were significantly decreased in comparison to the interrupted suture group (15.67 ± 3.30 vs. 22.17 ± 2.03, 167.11 ± 35.20 vs. 236.45 ± 21.70 CNY, p

Objectives: Perianastomotic ulceration (PAU) is an uncommon but potentially devastating condition, with a wide range of presenting symptoms. However, treatment approaches differ between centres as they are well known to be difficult to treat, and recurrences are common. Methods: This is a case series with literature review on PAU. We report 2 cases under the care of a tertiary pediatric surgical centre in Hong Kong with a background of neonatal necrotizing enterocolitis who underwent massive bowel resection, followed by small bowel to large bowel anastomosis. Results: The presentation of PAU was delayed for a median of 38 months, with varying severity of presentation from per rectal bleeding without need for transfusion to massive gastrointestinal bleeding requiring pediatric intensive care unit admission and immediate laparotomy. Recurrent bleeding was still evident in one of the patients after multiple courses of anti-inflammatory agents. Conclusions: PAU is a rare condition as a result of multiple factors and a consensus on management is lacking. Patients with short bowel syndrome with small to large bowel anastomoses appear to be more prone to PAU development. Due to its delayed presentation, long-term follow up and regular surveillance for PAU for patients with short bowel syndrome is recommended.

There is a great clinical need for biodegradable materials. This study aimed to investigate the effects of Mg–6Zn and titanium alloy stapler nails on intestinal anastomosis healing mediated via the TGF-β/Smad signaling pathway, as reflected in collagen metabolism in rabbits. Side-to-side ileo-ileostomy was performed with linear stapler loaded with the two nails. The results showed that no obvious postoperative complications such as abdominal infection and anastomotic leakage were observed. General observation and scanning electron microscope showed that Mg–6Zn alloy nails remained intact in the first week, degraded significantly in the second week, and were little left in the third week, while the titanium alloy nails showed intact substrate throughout the experimental period. Immunohistochemical analysis showed that the expression of TGF-β1 in Mg–6Zn alloy group was higher than that in titanium alloy group after 1 week, but it increased slowly, arrived at a lower level in the third week. Collagen I showed an increased expression in Mg–6Zn alloy group, but decreased with time in titanium alloy group. An enhanced expression of collagen III in Mg–6Zn alloy group in the first week but much lower in the third week as compared to the titanium alloy group. The expression of smad2 in Mg–6Zn alloy group maintained a steady level, while in titanium alloy group it showed a general upward trend. The expression of smad3 in both groups held steady after 2 weeks, then in the third week, it showed a strong uptrend in Mg–6Zn alloy group, while decreased immediately in titanium alloy group. Our findings suggest that Mg–6Zn alloy nails degraded significantly within 3 weeks and could provide stability of intestinal anastomosis in the reconstruction of intestinal tract. TGF-β/Smad signaling pathway may play a role in regulation of baseline collagen synthesis throughout the process. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leakages (ALs) are one of the most serious complications following gastrointestinal anastomosis. Currently, very few operative measures are available for the prevention of ALs. This pilot study aimed to evaluate the safety and efficacy of tube enterostomy (T-E) for the prevention of ALs in patients with high-risk intestinal anastomosis. Methods: In this retrospective study, demographic data and postoperative outcomes were compared among patients who received T-E and two historical cohorts: one group that underwent primary anastomosis without T-E (non-T-E group) and another that underwent conventional stoma construction without anastomosis (stoma group). The operative procedures were selected according to a scoring system that quantitatively evaluated risk of Als (Zhongnan score). Results: From March 2017 to March 2020, a total of 45 consecutive patients were enrolled in the T-E group. Among these patients, 53.3% (24/45) were diagnosed with Crohn's disease (CD), and 66.7% (30/45) of them underwent emergency surgery. After propensity score matching, the demographic data were comparable among the three groups. One case of AL (2.2%) occurred in the T-E group, while four cases of ALs (8.9%, 4/45) were found in the non-T-E group (p = 0.13). Tube feeding was provided to 33.3% (15/45) of the T-E patients. Major tube-related complications included one tube dislocation (2.2%) and 3 (6.7%) minor leakages after tube withdrawal (treated conservatively). One death occurred in the stoma group. In the subgroup analysis of CD patients, lower rates of ALs and abdominal abscesses were observed in the T-E group than in the non-T-E and stoma subgroups, but the differences were not significant. Conclusions: T-E seems to be a safe and feasible operative method for the protection of high-risk intestinal anastomosis, can be reversed and can provide enteral feeding with acceptable tube-related complications. Further studies are needed to validate the role of T-E. [ABSTRACT FROM AUTHOR]

Purpose: It is difficult to perform intestinal anastomosis in low-birth-weight infants because the intestinal diameter is small and the discrepancy in diameter of the proximal and distal intestines is often large, but there has been no optimal-sized training model. Therefore, we developed a new intestinal anastomosis training model that imitated the size of the intestine in low-birth-weight infants, and evaluated its face and construct validity. Methods: Two intestinal models were developed with crossMedical, Inc. using a hydrophilic acrylic material (wet model) or a polyurethane soft resin (dry model). The inner diameter of the simulated intestinal tract was 15 mm on the oral end and 6 mm on the anal end. Thirteen pediatric surgeons performed anastomosis and responded to the questionnaire. Results: In the questionnaire, the wet model had significantly higher scores than the dry model in "appearance", "softness" and "usefulness for training". In the anastomotic results of the wet model, the anastomosis leak pressure was significantly correlated with the number of intestinal anastomotic experiences in low-birth-weight infants (correlation coefficient = 0.64, P = 0.035). Conclusions: The wet-type intestinal anastomosis model showed good face validity. Its leak pressure had a significant correlation with clinical experience; thus, construct validity was demonstrated. [ABSTRACT FROM AUTHOR]

Introduction. Wound regeneration is an important process in surgical interventions. Failure of an intestinal anastomosis is an important intestinal surgery problem. The objective of the study. To evaluate the effect of platelet-rich plasma (PRP) and compare the effectiveness of various application methods in intestinal anastomosis regeneration in rabbits. Methods. Platelet-rich auto-plasma was obtained from 81 rabbits, which was used to study two methods of applying PRP (injection into the muscle layer / soaking in the intestinal wall) in comparison with the control group, on the end-to-end small-intestinal anastomosis. Results. The analysis of the histological and morphometric data showed that the regeneration between the samples of intestinal anastomosis treated with PRP soaking and injections into the intestinal wall is more favorable in comparison with the control group, which, in turn, was determined by the quantitative ratio of inflammatory infiltrate, fibroblast proliferation, neo-angiogenesis, and collagen deposition. PRP soaking in the intestinal wall significantly increased the number of adhesions battles. The analysis of the deformation and strength characteristics of the formed anastomoses also showed significantly high values ​​of the rupture strength of the anastomoses treated with PRP, in contrast with the control group. Conclusion. PRP injection into the muscular layer of the intestinal wall significantly reduces the development of adhesions in comparison with the PRP-saturated group of intestinal anastomoses. Further research is needed to clarify the optimal method of PRP application, which will improve the regeneration of the intestinal anastomosis.

Introduction: The use of staples to perform intestinal anastomosis in children has gained popularity in the past years. The aim of this study is to evaluate the outcomes of pediatric patients who underwent intestinal anastomosis with a 5-mm staple in a tertiary health care center. Material and Methods: From April 2017 to November 2019, the records of all pediatric patients who underwent intestinal anastomosis with a 5-mm staple were retrospectively revised. The reconstruction technique was functional end-to-end anastomosis. Results: A total of 12 intestinal anastomoses were evaluated. Mean age at surgery was 120 days. Small bowel anastomosis was the most frequently performed procedure (eight cases). Stapling difficulties were found in 3 patients. The anastomosis could not be performed with the 5-mm endostapler in one of these patients. The median follow-up was 26 months (interquartile range 20-40 months). Postoperative complications included one bowel obstruction that was surgically treated. Conclusions: Mechanical suturing with 5-mm staple is a safe alternative technique to perform intestinal anastomosis in neonates and infants. The use of this staple has proven to be safe and feasible in pediatric patients. It is necessary to select patients carefully according to their bowel characteristics. [ABSTRACT FROM AUTHOR]

the aim of this clinical trial was to evaluate the safety and efficacy of early enteral feeding (EEN) following intestinal anastomosis in neonates with congenital gastrointestinal malformation. a multicenter, prospective, randomized controlled trial (registered under chictr.org.cn Identifier no.ChiCTR-INR-17014179) was conducted between 2018 and 2019. Four centers in China analyzed 156 newborns of congenital gastrointestinal malformation undergoing intestinal anastomosis to EEN group (n = 78) or control (C) group (n = 78). The primary outcomes of this study were length of postoperative stay (LOPS) and time to full feeds. Secondary outcomes included morbidity of complications, parenteral nutrition (PN) duration, feeding intolerance, 30 day mortality rate and 30 day readmission rate. the mean time to full feeds and LOPS in the EEN group were 15.0 (9.8–22.8) days and 17.6 (12.0–29.8) days, while that were 18.0 (12.0–24.0) days and 20.0 (15.0–30.3) days in C groups respectively. There was no significant difference between two groups(P >0.05). No significant intergroup difference was found with respect to postoperative morbidity, PN duration or feeding intolerance(P >0.05). early enteral feeding following intestinal anastomosis in neonates with congenital gastrointestinal malformation is safe. Post-operative outcomes demonstrated a trend toward improvement. Level Ⅰ. [ABSTRACT FROM AUTHOR]

Gastroduodenal bleeding is one of the most challenging issues in surgery nowadays. The crude mortality rate due to severe blood loss in gastrointestinal bleeding is very high. Therefore, the use of medications to prevent severe blood loss and protect cells from the harmful effects of hypoxia should be the focus of attention in these conditions. This experimental study was carried out to establish changes in blood parameters and humoral immunity in rats after intestinal anastomoses combined with acute blood loss after the application of catholyte and anolyte. The study included 45 male Wistar rats weighing 290-320 g that were divided equally (15 animals per group) into three groups of intact animals (group 1), animals exposed to the small bowel resection (1.5 cm) with the end-to-end anastomosis and simulated acute blood loss (group 2), and animals exposed to the small bowel resection with end-to-end anastomosis and simulated acute blood loss that were daily given catholyte in the postoperative period group (group 3). After the surgery, the rats were given a catholyte solution per os, and the operative wound was treated with an anolyte. The blood samples and the wall of the small intestine in the anastomotic zone were used as a biological substrate to study the effect of catholyte on changes in the body during the healing process. The experiment was conducted for 15 days, and the data were recorded in two intervals on the 5th and 15th days after starting the experiment. The analyzed materials evidenced that the use of catholyte and liquid with negative oxidoreduction potential (ORP) (minus 500-520 mV) resulted in positive changes in the blood cell count, humoral immunity, and phagocytic activity impaired after the small bowel resection and blood loss. The use of an anolyte disinfectant (liquid with positive ORP+710-770 mV) prevented bacterial contamination of the surgical wound. The obtained findings proved that the catholyte had a positive effect on humoral immunity and healing processes in the anastomotic zone. Furthermore, the anolyte prevented the development of purulent complications and inflammation in the area of the surgical wound, and therefore, promoted the healing processes. [ABSTRACT FROM AUTHOR]

Purpose: Delayed enteral feeding (DEF) contributes to postoperative complications among children undergoing intestinal surgery. Various recent studies indicate the benefits of early enteral nutrition after intestinal surgery in adults. This systematic review and meta-analysis evaluates whether early enteral feeding (EEF) is beneficial in children who underwent intestinal anastomosis. Methods: MEDLINE, PubMed, the Cochrane Library, and Web of Science databases were searched for RCTs that addressed the effect of EEF in children (younger than 18 years old) undergoing intestinal anastomosis. EEF was defined as starting enteral feeding before the 3rd postoperative day. Studies were selected based on predetermined inclusion and exclusion criteria. A meta-analysis was performed using RevMan 5.3 to estimate odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Results: Four RCT studies met the inclusion criteria, comprising 97 cases with EEF and 89 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = − 2.80; 95% CI − 3.11 to − 2.49; p < 0.00001). Postoperative anastomotic leak rate was unchanged between EEF and DEF groups (OR = 0.86; 95% CI 0.17–4.46; p = 0.86). The EEF group had a shorter length of hospital stay (MD = − 3.38; 95% CI − 4.29 to − 2.48; p < 0.00001), earlier time to bowel movement return (MD = − 0.57; 95% CI − 0.79 to − 0.35; p < 0.00001), lower incidence of surgical infection (OR = 0.27; 95% CI 0.08–0.90; p = 0.03), and faster tolerance of full enteral feeding (MD = − 2.00; 95% CI − 3.01 to − 2.79; p < 0.00001). Incidence of fever (OR = 0.37; 95% CI 0.10–1.31; p = 0.12), emesis, and abdominal distention (OR = 0.63; 95% CI 0.13–3.16; p = 0.58) were not different between the two groups. Conclusions: Early enteral feeding after intestinal anastomosis in children does not increase the risk of postoperative anastomotic leak, fever, emesis, and abdominal distention. However, early enteral feeding is beneficial as it promotes the return of bowel function, reduces the length of hospital stay and the incidence of surgical infection in comparison to delayed enteral feeding. [ABSTRACT FROM AUTHOR]

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims& Objectives: The hand-sewn method of bowel anastomosis is the most common because of its affordability, familiarity and easy availability of materials. It can be done in single or double layers, with different surgeons preferring one technique over the other. Double layer intestinal anastomosis (DLIA) is time-consuming, challenging to perform, and carries possibly a higher risk of devascularisation, infection, and necrosis. Studies conducted so far do not show a significant difference between the two, but have concluded that more studies are required to determine this definitively. This study attempted to see whether the single layer intestinal anastomosis (SLIA) is non-inferior to DLIA in terms of incidence of anastomotic leak. It also compared mortality, morbidity, and length of hospitalization (LOH) between the two groups.Materials and Methods: This was a parallel arm, open labelled, non-inferiority randomized controlled trial conducted in the department of surgery in a tertiary care centre between October 2016 and March 2018. Patients who fulfilled the inclusion criteria were randomly allotted to two groups: Patients undergoing SLIA and patients undergoing DLIA. After the procedure, all patients were assessed for anastomotic leak, morbidity, mortality and LOH in the postoperative period. A 3-month follow-up period was observed for complications.Results: A total of 106 patients were randomised, 52 in SLIA and 54 in DLIA. Baseline demographic and clinicopathological characteristics between the two groups were comparable. The most common indication for intestinal anastomosis was ostomy closure in both groups. There was no significant difference between the two groups in terms of anastomotic leak, other complications, mortality and LOH.Conclusion: SLIA was comparable to DLIA with respect to incidence of anastomotic leak, morbidity, mortality, and the length of hospitalization, and can be considered as a safe and feasible alternative, in elective and emergency settings. [ABSTRACT FROM AUTHOR]

Purpose: Our animal studies have demonstrated the safety and feasibility of end-to-end intestinal anastomosis using a stent for laparoscopic colonic surgery. Therefore, we designed a non-inferiority trial to investigate the outcomes of stent anastomosis (SA) vs. those of conventional hand-sewn anastomosis (CA). Methods: A multicenter randomized controlled trial was conducted between December, 2016 and April, 2018. The primary outcome was the healing condition of the anastomoses, evaluated by endoscopy 6 months postoperatively. The secondary outcomes were the anastomotic completion time, anastomotic leak, intestinal obstruction, peritoneal effusion, and bleeding. Quality of life (QOL) was evaluated by questionnaires. Results: The subjects of this study were 60 patients, randomly divided into a SA group (n = 30) and a CA group (n = 30). There were no differences in anastomotic healing conditions (P = 1.00). The stent procedure was associated with a significantly shorter anastomosis time than the hand-sewn anastomosis (13.517 ± 4.281 vs. 20.333 ± 2.998 min, respectively; P < 0.001). There were no significant differences in anastomotic leakage, intestinal obstruction, peritoneal effusion, or bleeding between the groups. Questionnaires revealed almost no discrepancy between baseline QOL scores and those assessed 2, 4, 8, 12, and 24 weeks postoperatively in either group. Conclusions: Intestinal anastomosis with a stent is a non-inferior strategy for laparoscopic colonic surgery, which requires less time for the anastomosis. [ABSTRACT FROM AUTHOR]

Background: Anastomotic leakage is a severe complication in gastrointestinal surgery. Different methods have been evaluated for anastomotic reinforcement to prevent anastomotic leakage. The aim of this study was to investigate the effect of a poly-ε-caprolactone (PCL) scaffold incorporated in the staple-line, on the anastomotic strength and histological wound healing, of small intestinal anastomoses in piglets. Method: This randomized experimental trial included 17 piglets. In each piglet, three end-to-end anastomoses were performed in the small intestine with a circular stapler, i.e. one control and two interventional anastomoses. On postoperative day 5, the anastomoses were resected and subjected to tension stretch test and histological examination. Results: No anastomotic leakage occurred. In the interventional anastomoses, the mean value for maximal tensile strength was 15.7 N, which was significantly higher than control anastomoses 12.7 N (p = 0.01). No statistically significant differences were found between the two groups in the histopathological parameters. Conclusion: To conclude, this study has shown that the incorporation of a PCL scaffold in the staple-line was feasible and significantly increased the maximal tensile strength of small intestine anastomoses in piglets on postoperative day 5. The difference in histological parameters was not significantly distinct. [ABSTRACT FROM AUTHOR]