Sutureless small bowel anastomoses: Experimental study in pigs

Objective: To evaluate a new technique for experimental anastomosis with fi brin glue, and to compare the results with those of stapled and one-layer s utured anastomosis. Design: Open laboratory study. Setting: Teaching hospital, Sweden. Animals: Ten Swedish domestic pigs. Interventions: Each pig had three anastomoses made in the small bowel, one by each technique. The pigs were killed on the 4th postoperative day. Main outcome measures: Blood flow, collagen concentration, anastomotic inde x, breaking strength, thickness of bowel wall, and histological appearance. Results: Two pigs died postoperatively, leaving 8 for analysis. The blood f low at each anastomotic site studied by the microsphere technique was simil ar irrespective of the type of anastomosis (p = 0.3), as was anastomotic co llagen concentration (p = 0.09). The anastomotic index, however, was signif icantly higher in the stapled than in the glued or sutured ones (p = 0.03). The glued anastomosis was the weakest, being only one fifth the strength o f the stapled and one third the strength of the sutured anastomosis. There was no sign of rejection of the glue (of human origin) on histological exam ination. Glued and stapled anastomoses showed signs of mild inflammation, w hich did not reach the intensity of that around the sutured anastomoses. Conclusion: It is possible to make a sutureless anastomosis that does not l eak with a modified stapler using fibrin glue instead of staples, but the a nastomosis has considerably lower breaking strength than either stapled or sutured anastomoses.