A MICROSCOPICALLY INTACT GASTROINTESTINAL ANASTOMOSIS: METHODS OF CONSTRUCTION AND MEANS OF ASSESSMENT

Recent research reveals that healing of anastamotic wounds can be impaired by the adherence of gut bacteria to exposed collagen. Sutures and staples create a network of microscopic channels along the inverted cut bowel edge which may promote bacteria-mediated anastomotic breakdown. Techniques that preserve microscopic tissue integrity may be key to preventing clinical anastomotic leaks. Our objective was to develop a sensitive assay to determine anastomotic integrity across various techniques including single-layer hand-sewn, stapled, adhesive and bipolar. All anastomoses were performed in an end-to- end fashion between segments of porcine small intestine; intact bowel served as a control. Prototypes were designed to facilitate technically consistent bipolar and adhesive anastomoses between everted bowel ends. The anastomotic lumen was placed in series with a low-flow, low-pressure circuit of concentrated fluorescein solution. Normal saline filled a chamber surrounding the anastomosis; extraluminal solution was periodically sampled for analysis. Fluorescein concentration was quantified with spectrophotometry. Intact controls and adhesive anastomoses showed minimal increase in fluorescein concentration. Over fifteen minutes the adhesive anastomoses leaked less than bipolar (p=0.05), stapled (p