Efficacy of single‑layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Li,Guo‑Cai; Xu,Yong; Zhang,Yu‑Chun; Zhang,Fang‑Cheng; Wang,Qi; Ma,Qing‑Jiu

doi:10.3892/ol.2014.2397

Efficacy of single‑layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Authors:
- Guo‑Cai Li
- Yong Xu
- Yu‑Chun Zhang
- Fang‑Cheng Zhang
- Qi Wang
- Qing‑Jiu Ma
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Affiliations: Department of General Surgery, Xi'an Gao Xin Hospital, Xi'an Jiao Tong University, Xi'an, Shaanxi 710075, P.R. China
Published online on: July 30, 2014 https://doi.org/10.3892/ol.2014.2397
Pages: 1567-1574

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Abstract

Surgery for digestive tract disease predominantly consists of reconstruction and anastomosis. Due to the difficult location, anastomosis is extremely challenging and the risk of complication increases accordingly. Traditional manual anastomosis and the application of a stapling device are insufficient. Therefore, the aim of this study was to investigate the feasibility and safety of a novel manual method in a difficult anastomotic location, consisting of a single‑layer continuous suture in the posterior wall. In total, 15 beagle dogs were included in the study; eight underwent surgery with the novel manual method for reconstruction and anastomosis of the digestive tract, while seven underwent surgery with the stapler device as a control. The subsequent postoperative complications were observed and, three months later, the anastomotic ports were excised, and the pathological formation and morphological changes were evaluated. No statistically significant differences were identified between the total (50.0 vs. 57.1%; P=0.782) and anastomotic (0.0 vs. 28.6%; P=0.200) complication rates in the manual suture and staple suture groups, respectively. Compared with the control group, the operative expenditure was lower in the manual group (1726.7±33.5 vs. 2135.7±43.1 renminbi; P=0.001), the diameter of the anastomotic port was larger in the manual group (3.04±0.07 vs. 2.24±0.25 cm; P=0.004) and the thickness of the anastomotic port (in cm) was thinner in the manual group (2.94±0.06 vs. 5.07±0.85; P=0.002). Furthermore, the pathological formation of the anastomositic port in the manual group was improved. The results of the current study suggest single‑layer continuous suture of the posterior wall in anastomosis of the digestive tract to be a novel method with feasibility and safety, particularly in difficult anastomotic locations.

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1	Briel JW, Tamhankar AP, Hagen JA, et al: Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg. 198:536–542. 2004.
2	Kirat HT, Kiran RP, Lian L, Remzi FH and Fazio VW: Influence of stapler size used at ileal pouch-anal anastomosis on anastomotic leak, stricture, long-term functional outcomes, and quality of life. Am J Surg. 200:68–72. 2010.
3	Polk HC, Cheadle WG and Frankllin GA: Principles of operative surgery. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. Towsend CM: 16th edition. WB Saunders Company; St. Louis, MO: pp. 163–170. 2001
4	Graffner H, Andersson L, Löwenhielm P and Walther B: The healing process of anastomoses of the colon. A comparative study using single, double-layer or stapled anastomosis. Dis Colon Rectum. 27:767–771. 1984.
5	Orringer MB, Marshall B and Iannettoni MD: Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg. 119:277–288. 2000.
6	Docherty JG, McGregor JR, Akyol AM, Murray GD and Galloway DJ: Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg. 221:176–184. 1995.
7	Markar SR, Karthikesalingam A, Vyas S, Hashemi M and Winslet M: Hand-sewn versus stapled oesophago-gastric anastomosis: systematic review and meta-analysis. J Gastrointest Surg. 15:876–884. 2011.
8	Ziv Y, Fazio VW, Church JM, et al: Stapled ileal pouch anal anastomoses are safer than handsewn anastomoses in patients with ulcerative colitis. Am J Surg. 171:320–323. 1996.
9	Orsay CP, Bass EM, Firfer B, Ramakrishnan V and Abcarian H: Blood flow in colon anastomotic stricture formation. Dis Colon Rectum. 38:202–206. 1995.
10	Chung RS: Blood flow in colonic anastomoses. Effect of stapling and suturing. Ann Surg. 206:335–339. 1987.
11	Wong J, Cheung H, Lui R, et al: Esophagogastric anastomosis performed with a stapler: the occurrence of leakage and stricture. Surgery. 101:408–415. 1987.
12	Berrisford RG, Page RD and Donnelly RJ: Stapler design and strictures at the esophagogastric anastomosis. J Thorac Cardiovasc Surg. 111:142–146. 1996.
13	Ozkan O and Ozgentaş HE: Open guide suture technique for safe microvascular anastomosis. Ann Plast Surg. 55:289–291. 2005.
14	Valdivieso A, Sarabia S, Pocino R, et al: Is it worth using mechanical sutures in gastric surgery? Acta Chir Belg. 95(Suppl 4): S179–S181. 1995.
15	Fok M, Ah-Chong AK, Cheng SW and Wong J: Comparison of a single layer continuous hand-sewn method and circular stapling in 580 oesophageal anastomoses. Br J Surg. 78:342–345. 1991.
16	Law S, Fok M, Chu KM and Wong J: Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg. 226:169–173. 1997.
17	Hsu HH, Chen Js, Huang PM, Lee JM and Lee YC: Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg. 25:1097–1101. 2004.
18	Laterza E, de’Manzoni G, Veraldi GF, et al: Manual compared with mechanical cervical oesophagogastric anastomosis: a randomised trial. Eur J Surg. 165:1051–1054. 1999.
19	Valverde A, Hay JM, Fingerhut A and Elhadad A: Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: a controlled trial. French Associations for Surgical Research. Surgery. 120:476–483. 1996.
20	Walther B, Johansson J, Johnsson F, Von Holstein CS and Zilling T: Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg. 238:803–814. 2003.
21	Luechakiettisak P and Kasetsunthom S: Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study. J Med Assoc Thai. 91:681–685. 2008.
22	Okuyama M, Motoyama S, Suzuki H, et al: Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled study. Surg Today. 37:947–952. 2007.
23	Craig SR, Walker WS, Cameron EW and Wightman AJ: A prospective randomized study comparing stapled with handsewn oesophagogastric anastomoses. J R Coll Surg Edinb. 41:17–19. 1996.
24	George WD: Suturing or stapling in gastrointestinal surgery: a prospective randomize study. West of Scotland and Highland Anastomosis Study Group. Br J Surg. 78:337–341. 1991.
25	Kuroyanagi H, Oya M, Ueno M, et al: Standardized technique of laparoscopic intracorporeal rectal transaction and anastomosis for low anterior resection. Surg Endosc. 22:557–561. 2008.
26	Bärlehner E, Benhidjeb T, Anders S and Schicke B: Laparoscopic resction for rectal cancer Outcomes in 194 patients and review of the literature. Surg Endosc. 19:757–766. 2005.
27	Scheidbach H, Schneider C, Konradt J, et al: Laparoscopic abdominoperineal resection and anterior resection with curative intent for carcinoma of the rectum. Surg Endosc. 16:7–13. 2002.
28	Karanjia ND, Corder AP, Holdsworth PJ and Heald RJ: Risk of peritonitis and fatal septicaemia and the need to defunction the low anastomosis. Br J Surg. 78:196–198. 1991.
29	Dziki AJ, Duncan MD, Harmon JW, et al: Advantages of handsewn over stapled bowel anastomosis. Dis Colon Rectum. 34:442–448. 1991.
30	Henriques AC, Godinho CA, Saad R Jr, et al: Esophagogastric anastomosis with invagination into stomach: New technique to reduce fistula formation. World J Gastroenterol. 16:5722–5726. 2010.
31	Valenzuela P, Saiz Puente MS, Valero JL, et al: Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears: a randomised controlled trial. BJOG. 116:436–441. 2009.
32	Shoji Y, Nihei Z, Hirayama R and Mishima Y: Experiences with the linear cutter technique for performing Roux-en-Y anastomosis following total gastrectomy. Surg Today. 25:27–31. 1995.
33	Hirahara N, Monma H, Shimojo Y, et al: Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy. World J Surg Oncol. 9:552011.
34	Park KJ, Woo JS, Jeong SS and Yi JH: Continuous ‘over and over’ suture for tricuspid ring annuloplasty. Korean J Thorac Cardiovasc Surg. 45:19–23. 2012.