Comparison of skin staples with sutures for anastomosis of the small intestine in dogs

Objectives-To develop a technique for approximation of end-to-end intestina l anastomoses by using a disposable skin stapler and to compare the staplin g technique with an interrupted hand-sewn approximating end-to-end anastomo sis of the canine jejunum. Study Design-In vitro evaluation of the stapling technique, followed by an in vivo study of healing and clinical response in dogs. Animal Population-18 mixed-breed adult dogs. Methods-The anastomotic technique was developed and tested in fresh canine jejunum. Fourteen stapled approximating anastomoses (SAA) and 14 hand-sewn approximating anastomoses (HAA) were performed in 6 cadavers under simulate d surgical conditions. Anastomotic construction times, initial bursting str engths, initial lumen diameters, and gross appearance of the 2 techniques w ere compared. Healing and clinical response were evaluated in 12 purpose-br ed dogs assigned to 2 groups of 6 animals each. Each dog had 1 SAA and 1 HA A performed in the jejunum, 50 cm apart. Six dogs were killed on postoperat ive day 4, and 6 dogs were killed on postoperative day 21. Anastomotic cons truction time, gross and histological healing, bursting strength, lumen dia meter, and circumference were compared between techniques. Results-Mean construction time for SAA was significantly faster than for HA A (P = .0001). None of the anastomoses leaked, and there were no major clin ical complications in any dog. Bursting strengths were not significantly di fferent at any time for the 2 techniques. Initial bursting strength was 31% to 35% of the normal jejunum. A nonsignificant decrease in bursting streng th was observed by postoperative day 4 (26% to 28% of normal), and a signif icant increase in bursting strength was observed by postoperative day 21 (1 00% to 109% of normal). Neither technique decreased the initial lumen diame ter. However, bath techniques resulted in a similar degree of luminal steno sis as the anastomoses healed. Anastomotic lumen diameter was significantly decreased from normal in both groups at day 4 (86% to 88% of normal) and d ay 21 (90% to 91% of normal). There was no significant difference between t he circumference of the anastomoses and normal jejunum at any time. Histolo gical analysis showed similar healing for the hand-sewn and stapled techniq ues at 4 and 21 days after surgery. For both surgical techniques, day 21 an astomoses had significantly less inflammation and necrosis, significantly m ore fibrosis, and significantly better continuity of histological layers wh en compared with day 4 anastomoses. Conclusion-Approximating end-to-end intestinal anastomosis with a skin stap ler is equivalent in bursting strength, lumen diameter, lumen circumference , and healing characteristics to the traditional hand-sewn technique, but i t can be performed in significantly less time. Clinical Relevance-Skin stapling devices can be used to create technically simple, rapid, and safe end-to-end anastomoses in canine jejunum. (C) Copyr ight 2000 by The American College of Veterinary Surgeons.