BLOOD, FLOW IN COLON ANASTOMOTIC STRICTURE FORMATION

PURPOSE: The influence of both blood now and anastomotic technique on the development of anastomotic stricture formation was studied using a dog model. METHODS: Fifty-three dogs underwent distal colocolonic ana stomosis with either an EEA(TM) (U. S. Surgical Corp., Norwalk, CT) ci rcular stapler or a Czerny-Lembert two-layered, handsewn anastomosis. Blood now was measured by Laser Doppler Velocimetry using the Laserflo BPM(2)(TM) (Vasamedics Inc., St. Paul, MN). The animals were separate d into three blood now groups: greater than or equal to 62.5 percent o f normal blood how, between 37.5 percent and 62.5 percent of normal bl ood now, and less than or equal to 37.5 percent of normal blood now. E ach blood how group had an anastomosis performed by either stapling or by hand sewing techniques. At six weeks, the anastomoses were opened longitudinally and fixed to determine the anastomotic index (AI). AI i s defined as two times the anastomotic circumference over the proximal circumference plus the distal circumference. Blood now groups and ana stomotic technique groups were compared with an interaction variable f or the outcome, AI using a two-way analysis of variance. RESULTS: The AI of the stapled anastomoses was found to be significantly higher tha n handsewn anastomoses (P < 0.006). There was no difference in AI betw een different blood now groups and no correlation of observed histolog ic findings with AI. CONCLUSION: Clinically relevant ischemia does not directly influence stricture formation in either handsewn or stapled distal colonic anastomoses.