PURSE-STRING SUTURE FOR STAPLED ESOPHAGOGASTRIC ANASTOMOSIS - HAND-SEWN VERSUS AUTOMATIC

An automatic purse-string device was compared with the traditional han d-sewn method in stapled oesophageal anastomosis. Fifteen greyhound do gs underwent distal oesophagectomy with stapled gastro-oesophageal ana stomosis; a purse-string suture was used to draw the distal oesophagus around the stapling device. The animals were randomized into group 1 (n = 8), in which the automatic device was used, and group 2 (n = 7), in which the oesophageal purse string was hand-sewn. The automatic dev ice failed to incorporate the oesophageal mucosa and submucosa reliabl y into the anastomotic staple line. There were five defective anastomo ses in group 1 and none in group 2 (P = 0.037). Anastomotic bursting p ressures were significantly reduced in group 1 compared with group 2 ( median (range) 47 (22-110) versus 82 (68-88) mmHg, P = 0.032). Within group 1, a significant difference in bursting pressure existed between complete anastomoses and those in which the mucosa was not fully inco rporated (median (range) 75 (60-110) versus 39 (22-50) mmHg, P = 0.037 ). Median (range) breaking strengths where anastomoses were incomplete were lower than where all layers were incorporated (1420 (1250-2220) versus 1990 (1590-2475) g/cm, P = 0.009). This study questions the saf ety of the automatic purse-string device for oesophageal anastomosis w hen used in accordance with present recommendations. Further evaluatio n and possibly modification of either the instrument design or the met hods recommended by the manufacturer for its use are warranted.