ASEPTIC LAPAROSCOPIC COLON RESECTION WITH INTRAABDOMINAL ANASTOMOSIS - AN EXPERIMENTAL-STUDY IN PIGS

Background: We evaluated a new aseptic method for laparoscopic left co lon resection in terms of technical feasibility and outcome. Methods: Ten pigs were operated on under general anesthesia. Pre- and postopera tive body weight, stools, behavior, and need for analgesics were recor ded. Fourteen days later, the animals were killed. At autopsy, the deg ree of intraabdominal adhesions was noted. The anastomoses were sent f or histological examination. The entire procedure was performed intrac orporeally, and no antibiotics were given. After division of the mesoc olon, the segment to be resected was invaginated down through the colo n. This was facilitated by a custom-made instrument that was introduce d into the bowel via the anus; it consisted of a pull-out device and a modified diathermy wire. The anastomosis was completed at the invagin ation fold by a row of hernia staples that were covered by an interrup ted suture, Then the invaginated bowel was transected by the diathermy wire and delivered through the anus. Results: One animal was killed b efore completion of the operation because of a colonic perforation. Th e remaining nine animals had an uneventful and rapid recovery. They at e from the Ist postoperative day and gained weight rapidly. Stools wer e normal after 2 days (median), and normal behaviour was noted in all animals from the Ist postoperative day. At the postmortem examination, intraabdominal adhesions were observed in two animals. In one case, t he adhesions extended from a hematoma in the mesentery to the abdomina l wall. There were no adhesions to the anastomosis or the colon. In th e other case, the anastomosis adhered to the right uterine tube and a loop of small intestines. Conclusions: The method is technically feasi ble, but a modification is suggested for cases where the invagination is impossible. Recovery after the operation is rapid.