Double 90 Degrees Counterrotated End-to-End-Anastomosis: An Experimental Study of an Intestinal Anastomosis Technique.

AimThe aim of the article is to investigate a new anastomotic technique compared with standardized intestinal anastomotic procedures. Materials and MethodsA total of 32 male Wistar rats were randomized to three groups. In the Experimental Group (n=10), the new double 90 degrees inversely rotated anastomosis was used, in the End Group (n=10) a single-layer end-to-end anastomosis, and in the Side Group (n=12) a single-layer side-to-side anastomosis. All anastomoses were done using interrupted sutures. On postoperative day 4, rats were relaparotomized. Bursting pressure, hydroxyproline concentration, a semiquantitative adhesion score and two histological anastomotic healing scores (mucosal healing according to Chiu and overall anastomotic healing according to Verhofstad) were collected. Most data are presented as median (range). p<0.05 was considered significant. ResultsAnastomotic insufficiency occurred only in one rat of the Side Group. Median bursting pressure in the Experimental Group was 105mm Hg (range=72-161mm Hg), significantly higher in the End Group (164mm Hg; range=99-210mm Hg; p=0.021) and lower in the Side Group by trend (81mm Hg; range=59-122mm Hg; p=0.093). Hydroxyproline concentration did not differ significantly in between the groups. The adhesion score was 2.5 (range=1-3) in the Experimental Group, 2 (range=1-2) in the End Group, but there were significantly more adhesions in the Side Group (range=3-4); p=0.020 versus Experimental Group, p<0.001 versus End Group. The Chiu Score showed the worst mucosal healing in the Experimental Group. The overall Verhofstad Score was significantly worse (mean=2.032; standard deviation [SD]=0.842) p=0.031 and p=0.002 in the Experimental Group, compared with the Side Group (mean=1.729; SD=0.682) and the End Group (mean=1.571; SD=0.612). ConclusionThe new anastomotic technique is feasible and did not show any relevant complication. Even though it was superior to the side-to-side anastomosis by trend with respect to functional stability, mucosal healing surprisingly showed the worst results. Classical end-to-end anastomosis still seems to be the best choice regarding structural and functional anastomotic stability.