Safety and effectiveness of mechanical versus hand suturing of intestinal anastomoses in an animal model of peritonitis

Tajima,Masaaki; Kono,Yohei; Ninomiya,Shigeo; Amin,Anwar  Tawfik; Inomata,Masafumi; Shiraishi,Norio; Kitano,Seigo

doi:10.3892/etm.2012.588

Safety and effectiveness of mechanical versus hand suturing of intestinal anastomoses in an animal model of peritonitis

Authors:
- Masaaki Tajima
- Yohei Kono
- Shigeo Ninomiya
- Anwar Tawfik Amin
- Masafumi Inomata
- Norio Shiraishi
- Seigo Kitano
View Affiliations

Affiliations: Department of Surgery I, Faculty of Medicine, Oita University, Oita, Japan
Published online on: May 23, 2012 https://doi.org/10.3892/etm.2012.588
Pages: 211-215

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Mechanical stapling for colorectal anastomosis is popular, but the safety of its use for anastomosis in peritonitis is unclear. We evaluated the safety and effectiveness of mechanically stapled vs. hand-sutured anastomosis by comparing wound healing in an animal model of bacterial peritonitis. Male Sprague-Dawley (n=48) rats underwent cecal ligation and puncture. After 24 h, rats were divided into two groups: the stapler group (cecal resection with mechanical stapler, n=24) and the hand-sutured group (cecal resection and stump closure with surgical absorbable suture, n=24). Anastomotic segments were excised and as indicators of wound healing, anastomotic bursting pressure (ABP) and tissue hydroxyproline concentration were determined over time. After harvesting, anastomotic segments were analyzed by quantitative real-time polymerase chain reaction (PCR) to determine relative expression of transforming growth factor-β1 (TGF-β1) and vascular endothelial growth factor (VEGF) normalized to that of a constitutive gene. The operative time was significantly shorter in the stapler vs. the hand-sutured group. Both groups showed progressive increases in ABP over the postoperative period. ABP was significantly higher in the stapler vs. the hand-sutured group on postoperative days (PODs) 0 and 3. Tissue hydroxyproline concentration increased from POD 7 in both groups, but between-group difference was not significant. Both groups showed progressive increases in TGF-β1 and VEGF expression during the 7-day postoperative period. On POD 5, TGF-β1 gene expression was higher in the stapler vs. the hand-sutured group. VEGF gene expression was identical in both groups. In conclusion, anastomosis by stapler is safer and more effective than that by hand suturing in bacterial peritonitis, since it requires less operating time and creates stronger anastomoses in the early postoperative period.

View Figures

View References

1.	Guenaga KF, Matos D, Castro AA, Atallah AN and Willejorgensen P: Mechanical bowel preparation for elective colorectal surgery. Cochrane Databese Syst Rev. 2:CD0015442003.
2.	Peeters KC, Tollenaar RA, Marijnen CA, et al: Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg. 92:211–216. 2005. View Article : Google Scholar
3.	Everett WG, Friend PJ and Forty J: Comparison of stapling and hand suture for left sided large bowel anastomosis. Br J Surg. 73:345–348. 1986. View Article : Google Scholar : PubMed/NCBI
4.	Kataoka M, Masaoka A, Hayashi S, et al: Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy. Ann Surg. 209:99–104. 1989. View Article : Google Scholar : PubMed/NCBI
5.	West of Scotland and Highland Anastomosis Study Group: Suturing or stapling in gastrointestinal surgery: a prospective randomized study. Br J Surg. 78:337–341. 1991. View Article : Google Scholar : PubMed/NCBI
6.	Brennan SS, Pickford IR, Evans M and Pollok AV: Staplers or sutures for colonic anastomoses - a controlled clinical trial. Br J Surg. 69:722–724. 1982. View Article : Google Scholar : PubMed/NCBI
7.	Didolkar MS, Reed WP, Elias EG, Schnaper LA, Brown SD and Chaudhary SM: A prospective randomized study of sutured versus stapled bowel anastomoses in patients with cancer. Cancer. 57:456–460. 1986. View Article : Google Scholar : PubMed/NCBI
8.	Fielding LP, Stewart-Brown S, Blesovsky L and Kearny G: Anastomotic integrity after operations for large-bowel cancer: a multicentre study. Br Med J. 281:411–414. 1980. View Article : Google Scholar : PubMed/NCBI
9.	Buckmire MA, Parquet G, Greenway S and Rolandelli RH: Temporal expression of TGF-beta1, EGF, and PDGF-BB in a model of colonic wound healing. J Surg Res. 80:52–57. 1998. View Article : Google Scholar : PubMed/NCBI
10.	Cromack DT, Sporn MB, Roberts AB, Merino MJ, Dart LL and Norton JA: Transforming growth factor beta levels in rat wound chambers. J Surg Res. 42:622–628. 1987. View Article : Google Scholar : PubMed/NCBI
11.	Bauer SM, Bauer RJ, Liu ZJ, Chen H, Goldstein L and Velazquez OC: Vascular endothelial growth factor-C promotes vasculogenesis, angiogenesis, and collagen constriction in three-dimensional collagen gels. J Vasc Surg. 41:699–707. 2005. View Article : Google Scholar
12.	Wichterman KA, Baue AE and Chaudry IH: Sepsis and septic shock a review of laboratory models and a proposal. J Surg Res. 28:189–201. 1980. View Article : Google Scholar : PubMed/NCBI
13.	Ninomiya S, Inomata M, Tajima M, et al: Effect of Bevacizumab, a humanized monoclonal antibody to vascular endothelial growth factor, on peritoneal metastasis of MKN-45P human gastric cancer in mice. J Surg Res. 154:196–202. 2009. View Article : Google Scholar : PubMed/NCBI
14.	Stegemann H and Stalder K: Determination of hydroxyproline. Clin Chim Acta. 18:267–273. 1967. View Article : Google Scholar
15.	Blasken P, Renvall S and Sandberg M: Fibronectin and collagen gene expression in healing experimental colonic anastomoses. Br J Surg. 78:1048–1052. 1991. View Article : Google Scholar : PubMed/NCBI
16.	Fukuchi SG, Seeburger JL, Parquet G and Rolandelli RH: Influence of 5-fluorouracil on colonic healing and expression of transforming growth factor-beta 1. J Surg Res. 84:121–126. 1999. View Article : Google Scholar : PubMed/NCBI
17.	Sarah KT, Eugene YC and Blair AJ: Clinical review: healing in gastrointestinal anastomosis, part 1. Microsurgery. 26:131–136. 2006. View Article : Google Scholar
18.	Ahrendt GM, Gardiner K and Barbul A: Loss of colonic structural collagen impairs healing during intra-abdominal sepsis. Arch Surg. 129:1179–1183. 1994. View Article : Google Scholar : PubMed/NCBI
19.	Barnard JA, Warwick GJ and Gold LI: Localization of transforming growth factor beta isoforms in the normal murine small intestine and colon. Gastroenterology. 105:67–73. 1993.PubMed/NCBI
20.	di Mola FF, Friess H, Scheuren A, et al: Transforming growth factor-betas and their signaling receptors are coexpressed in Crohn's disease. Ann Surg. 229:67–75. 1999.PubMed/NCBI
21.	Migaly J, Lieberman J, Long W, et al: Effect of adenoviral-mediated transfer of transforming growth factor-β1 on colonic anastomotic healing. Dis Colon Rectum. 47:1699–1705. 2004.
22.	Seifert WF, Verhofstad AAJ, Wobbes T, et al: Quantitation of angiogenesis in healing anastomoses of rat colon. Exp Mol Pathol. 64:31–40. 1997. View Article : Google Scholar : PubMed/NCBI
23.	Kleespies A, Guba M, Jauch K and Burns CJ: Vascular endothelial growth factor in esophageal cancer. J Surg Oncol. 87:95–104. 2004. View Article : Google Scholar : PubMed/NCBI
24.	Henry TD: Therapeutic angiogenesis. BMJ. 318:1536–1539. 1999. View Article : Google Scholar : PubMed/NCBI
25.	Christensen H, Chemnitz J, Christensen B and Oxlund H: Collagen structural organization of healing colonic anastomoses and the effect of growth hormone treatment. Dis Colon Rectum. 38:1200–1205. 1995. View Article : Google Scholar : PubMed/NCBI
26.	Korolija D: The current evidence on stapled versus hand-sewn anastomosis in the digestive tract. Minim Invasive Ther Allied Technol. 17:151–154. 2008. View Article : Google Scholar : PubMed/NCBI
27.	Catena F, La Donna M, Gagliardi A, et al: Stapled versus hand-sewn anastomosis in emergency intestinal surgery: Results of a prospective randomized study. Surg Today. 34:123–126. 2004. View Article : Google Scholar : PubMed/NCBI