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Comparison of Strength of Anastomosis Between Four Different Techniques for Colorectal Surgery

友利, 賢太 東京慈恵会医科大学 DOI:info:doi/10.21873/anticanres.14143

2020.06.26

概要

Background/Aim: Advances in stapling devices have led to their widespread use in colorectal surgery. We compared the strength of four types of anastomoses using bursting pressure. Materials and Methods: We created stapled anastomosis models [double stapling technique (DST), functional end-to-end anastomosis (FEEA) unbuttressed or buttressed, and triangulating anastomosis (TA) with two- or three-row stapling] and a hand-sewn anastomosis model. Bursting pressures of each method were measured. The primary end point was the bursting pressure. The effectiveness of buttressing and three-row stapling were the secondary endpoints. Results: The DST group had significantly lower bursting pressure than TA with three-row stapling, FEEA buttressed, and hand-sewn groups. No significant difference was found between the bursting pressure of the FEEA unbuttressed and FEEA buttressed groups and that of the TA with two-row and three-row stapling groups. Conclusion: DST has the lowest bursting pressure compared to other anastomotic techniques. Buttressing suture and three-row stapling have no effect on the strength of anastomosis.

Successful anastomosis is an extremely important aspect of gastrointestinal surgery. Stapling devices have been widely used for anastomosis since the 1960s, when Steichen and Ravitch adopted the use of them (1-3). Stapled anastomosis is simple, reduces the duration of surgery, and reduces the stress that surgeons may experience (4). However, the rate of anastomotic leakage, the main complication of colorectal surgery, has not been reduced (5). Furthermore, stapled anastomosis is associated with higher rates of anastomotic leakage (6). For cases of rectal cancer surgery, the rate of anastomotic leakage is between 10% and 15% (7, 8). Anastomotic leakage could lead to severe conditions and poor prognoses, especially in cases of colorectal cancer (9-11). Although a wide variety of anastomotic techniques are available for colorectal anastomoses, it is not known which technique has the least chance of anastomotic leakage. Our retrospective study reported that the use of triangulating anastomosis (TA) for cases of colon cancer reduces anastomotic leakage (12, 13). Factors influencing anastomotic leakage include patient and operation factors (14-17), blood supply at the site of anastomosis, tension, and strength of the anastomosis (18-23). The blood supply and tension can be addressed by adjusting the surgical procedure. However, the strength of the anastomosis depends on the anastomosis technique and stapling device used. Stapling devices include two-row, three-row, and circular staplers. The stapling devices and anastomosis techniques are often selected by surgeons based on their experience and preferences. However, knowing the strengths of the various anastomosis techniques would aid in the selection of anastomosis technique used in the operation. Therefore, in this study, we created anastomosis models for the various techniques using a bovine intestinal tract and compared the bursting pressure by subjecting the models to bursting tests to elucidate the strengths of the various anastomosis techniques. The aim of this study was to evaluate the differences between the strengths of the various anastomotic techniques for colorectal surgery.

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参考文献

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