LAPAROSCOPIC INTESTINAL ANASTOMOSIS IN PI GS - COMPARATIVE-STUDY BETWEEN HANDSEWN AND STAPLING SUTURE

Laparoscopic intestinal anastomosis is not very reliable and needs to be evaluate in an experimental model in animals before being performed in man. The purpose of this study was to evaluate the feasibility, ef ficacy and safety of manual anastomosis comparatively to the standard stapling suture. Twenty female pigs weighing 20 +/- 5kg. were used for this study. A 5 cm ileal segment resection was performed under laparo scopy. The animals were assigned to 2 groups. Group I: 10 animals unde rwent end-to-end hand-swen anastomosis with Polyglactin 910, dec 1.5. Group II: 10 animals underwent side to-side anastomosis using the Endo stapler. Operating lime and anastomosis time were compared using the Mann-Whitney test for statistical analysis. On the 15th postoperative day, the animals were sacrificed and the anastomoses were evaluated. T here was no operating death in the 2 groups. The operative time was si gnificantly longer in group I than in group II (p < 0.01), with 180 +/ - 40 min vs 49 +/- 25 min respectively. This difference was due to the anastomosis time of 130 +/- 40 min vs 16 +/- 6 min respectively (p < 0.01). There was 1 postoperative death related to fistula and peritoni tis in group I and none in group II. The postoperative following showe d 5 anastomotic leakages (4 in group I and 1 in group II) and 2 relati ve stenoses in group I. This study shows the simplicity and rapidity o f performing stapling intestinal anastomosis under laparoscopy. Hand-s ewn anastomosis is technically more difficult to perform under laparos copy and requires a greater experience.