GASTROINTESTINAL SUTURELESS ANASTOMOSIS USING FIBRIN GLUE - REINFORCEMENT OF THE SLIDING ABSORBABLE INTRALUMINAL NONTOXIC STENT AND DEVELOPMENT OF A STENT PLACEMENT DEVICE

Sutureless anastomosis of the gastrointestinal tract using fibrin glue and sliding absorbable intraluminal nontoxic stents (SAINTs) has two shortcomings, stent shaft breakage and the lack of a transanal inserti on device (TID) for low anterior resection. Reinforcement of the sucro se base SAINT (R-SAINT) is described. Sutureless anastomosis is attemp ted using a stapleless mechanical stapler (SS) and used as preprototyp e to screen histologically and mechanically for TID anastomoses in the small intestine. Finally, a prototype absorbable head SAINT placement device (SAINT-PD) intended for TID, similar to the SS, is utilized on the small intestine. Fifty-seven Landrace pigs weighing 25-35 kg were used to perform 58 anastomoses, including the small intestine (15 man ual, 19 SAINT, 11 SS, 5 R-SAINT, 6 SAINT-PD) and large intestine (2 R- SAINT). All anastomoses performed with the R-SAINT succeeded on the fi rst attempt even if the shaft cracked. The SS technique proved impract ical, but the histological screen results from 7 to 60 days did approx imate those of corresponding SAINT anastomoses. The SAINT-PD demonstra ted operational impr ovement over the SS, but the histological results were similar to both the SS and SAINT. The advantages of the R-SAINT and SAINT-PD are that they leave no foreign bodies or pressure clampin g devices at the anastomostic site. Larger studies may show the R-SAIN T and the SAINT-PD to be practical, new surgical tools in sutureless f ibrin glue anastomosis.