A COMPARATIVE-STUDY OF OPEN, LAPAROSCOPIC INTRACORPOREAL, AND LAPAROSCOPIC ASSISTED LOW ANTERIOR RESECTION AND ANASTOMOSIS IN PIGS

This study was done to investigate whether laparoscopic intracorporeal (LI) or laparoscopic assisted (LA) colon resection results in improve d anastomotic healing compared with open colon resection (OR). Thirty- six domestic swine were randomly assigned to undergo either LI, LA, or OR of the rectosigmoid. For OR cases, the sigmoid was resected throug h a midline incision, and a transanal end-to-end stapled anastomosis w as constructed with an ILS device. For LA and LI cases, the sigmoid wa s laparoscopically mobilized and divided distally, using 5 trocar site s. For LA cases, the proximal sigmoid was brought out through an enlar ged trocar site and resected; the ILS anvil was secured to the proxima l end, and the colon was replaced in the abdominal cavity where the an astomosis was completed by transanal insertion and firing of ILS devic e. For LI cases, the sigmoid was resected laparoscopically and retriev ed through a 33 mm trocar. The ILS anvil was introduced via the same t rocar, and the device was laparoscopically secured with two Endoloop(R ) (Ethicon Endo-Surgery, Cincinnati, OH) pursestring sutures. The anas tomosis was completed the same way as for LA cases. Animals were kille d at 7 days, at which time the anastomoses were evaluated by barium en ema, bursting pressure, and histologic appearance. There were no radio graphic anastomotic leaks. The mean bursting pressure was 205 +/- 65 m mHg for the 13 OR animals, 240 +/- 53 mmHg for 11 LA animals, and 242 +/- 43 mmHg for the 12 LI animals (N.S.). Histologic evaluation for in flammation indicated no significant differences. Operative time was 50 +/- 8 minutes for OR, 71 +/- 30 minutes for LA (P = 0.05), and 84 +/- 7 minutes for LI cases (P = 0.0004). LA, LI, and OR of the sigmoid co lon result in comparable bursting strength, x-ray, and histologic appe arance at 7 days, although OR requires less operating time.