Hafiz Kashif Shahzad

Comparative Evaluation Of Conventional Method And Staple Suture Technique For Intestinal Aanastomosis In Dogs - 2013

Intestinal resection and anastomosis is frequently essential during abdominal surgeries. Indications for intestinal resection are malignancy, inflammation, stricture formation, injuries and ischemia. Several surgical situations necessitate the resection of intestinal segments and the formation of consistent anastomoses. Conventionally, a large diversity of suture materials has been used to make hand-sewn anastomoses. Surgical stapler was made for the first time at the beginning of 20th century but its use remained limited in gastrointestinal surgery. Currently, stapled anastomoses is an essential part of the majority of the gastrointestinal surgeries. The simple-interrupted, single-layer, approximating technique, in which absorbable monofilament suture material is used, is presently believed to be the technique of choice for end-to-end bowel anastomosis. This procedure is mostly used in gastrointestinal surgeries with comparatively lesser complications. Intestinal anastomosis with skin staples was started by military surgeons for the soldiers suffering from bowel trauma caused by gunfire. In this technique, stainless steel skin staples were used to create a seromuscular intestinal anastomoses. There are several types of staplers available in markets, e.g. circular ligators, clip appliers, endoscopic staplers etc. The circular stapler is a disposable anastomotic instrument that places a round, double staggered row of titanium staples connecting intervening tissues. It can generate an end-to-end, end-to-side, or side-to-side anastomosis. This round stapler is available with a variety of staple line diameters to be used according to need. In current years, there has been a large shift from hand-sewn method towards the use of intestinal stapler in gastrointestinal surgery. They present a possible reduction in operational timing and are easy to learn and use than for hand-sewn method. So, staplers are very popular in the trainee. This research project was tested on 12 mongrel dogs divided randomly into two different groups (A and B). Each group comprised of 6 dogs. Conventional hand-sewn method of end-to-end anastomosis was applied on group A and stapled anastomosis was made in the dogs of group B. Two surgical techniques were applied for end to end anastomosis of jejunum. In group-A conventional hand-sewn anastomosis technique was applied. In this method a piece of jejunum was removed and then anatomosed with simple interrupted, single-layer, approximating technique. The absorbable, monofilament suture material was applied manually. This is currently considered the method of choice for end-to-end intestinal anastomosis in small animal surgery. This technique is well described and has been used throughout the canine gastrointestinal tract with a relatively low complication rate. In group-B a circular mechanical stapler was used to construct anastomosis. In this method a piece of jejunum was removed and end-to-end anatomosis was made using a mechanical stapler. Comparison of both techniques was made on the basis of clinical parameters (temperature, pulse, respiration, vomiting, diarrhea and blood in feces), radiographic evaluation, exploratory laparotomy, change in lumen diameter and duration of surgical procedure. There is a significant difference in change in diameter within each group before and after surgery but there is no significant difference in change in diameter or stenosis formation between these two groups. There is a significant difference in the duration of operation; stapled group significantly requires an average of 10 minutes less than conventional hand-sewn method. Conclusively it was inferred that there is no significant difference in change in diameter between stapled group and hand sewn group but the anastomosis construction time is shorter in stapled group. Stapled anastomosis is safe and faster technique than hand-sewn method. The prevalence of low complication rate makes it all the more ideal for application in routine practices.

Department of Clinical Medicine & Surgery


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