Clinical and morphological features of multi-point and linear colon electrically welded anastomosis
DOI:
https://doi.org/10.11603/2414-4533.2018.3.9229Keywords:
anastomosis, colon, electric welding, radio frequency, instrument, bursting pressure, morphologyAbstract
The aim of the work: to study the influence onto clinical hermetic rupture properties the morphological transformations types inside the colon tissues during electrically welded anastomosis creation using linear or multi-point applying methods and various pressure characteristics of the instrument.
Materials and Methods. The swine colon sections 31 cm in diameter, were anastomosed in end-to-end way during acute experiment. There were 2 double-line stapled and 144 electro-welded anastomoses: 48 multy-point, made by toothed tweezers with a topical pressure of 1.8 N/mm2), and 56 linear circular (pressure 2.1 N/mm2 or 3.0 N/mm2).
The electric welding device "Patonmed" EKVZ-300 (440 kHz) was used. Anastomoses were tested by a slow liquid injection into closed section, up to 15 mm Hg/min. The 3 types electro-welding connections were divided by blind method to the injection groups. The first group injected up to 24.5 mm Hg. – the pressure of liquid outflow have established for stapled anastomoses. The second group was ruptured. Anastomoses then were sent for histological examination.
Results and Discussion. All welded anastomoses remained sealed at a bursting pressure 23.5 mm Hg, and reached a break: multi-point at (37.2±5.2) mm Hg. linear – (created under pressure of 2.1 N mm2) (53.6±9.8) mm Hg, linear (created under pressure 3.0 N/mm2) – (62.8±6.2) mm Hg. The linear anastomoses compound thickness varied from 0.1 to 0.3 mm, and differed slightly in morphological characteristics in 1/3 of its circumference segment, where a large proportion of the lacunas and the number of intervals between the merged coagulated muscle layers were found. The rupture occurred in such segment. Although the integrity of the welding coagulation changes along the anastomoses circumference was preserved. The density of the 3.0 N/mm2-created anastomosis was achieved by lover gaps number and wider layers merging inside the conglomerate. The multi-point anastomosis thickness fluctuated from 1.8 mm to 5 mm in regular. At the point of jagged electrodes edges have convergenced, the merge between the muscle layers were established, the cell fragments and fibers became orientated, and the bond conglomerate was formed. Nearby muscular layers did not merge as topical, although they are involved into coagulation conglomerate, which comprises the muscular and submucosal layers mainly. Serous layers were merged also.
References
Shogan, B.D., Belogortseva, N., Luong, P.M., Zaborin, A., Lax, S., Bethel, C., … Alverdy, J.C. (2015). Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak. Sci. Transl. Med., 7, 286ra, 68-68. doi: 10.1126/scitranslmed.3010658.
Yegorov, V.I., Schastlivtsev, I.V., Turusov, R.A. & Baranov, A.O. (2002). Mekhanicheskiye narusheniya pod nityu kishechnogo shva kak prichina narusheniy mikrotsirkulyatsii v oblasti soustiy [Mechanical abnormalities under the filament of the intestinal suture as a cause of microcirculation disorders in the region of anastomosis]. Annaly khirurgii – Annals of Surgery, 3, 66-68 [in Russian].
Neutzling, C.B., Lustosa, S.A.S., Proenca, I.M., da Silva, E.M.K. & Matos, D. (2012). Stapled versus handsewn methods for colorectal anastomosis surgery. Matos D. (Ed.). Cochrane Database Syst. Rev., 2. DOI: 10.1002/14651858.CD003144.pub2.
de Hingh, I.H., de Man, B.M., Lomme, R.M., van Goor, H. & Hendriks, T. (2003). Colonic anastomotic strength and matrix metalloproteinase activity in an experimental model of bacterial peritonitis. Br. J. Surg., 90, 981-988. doi.org/10.1002/bjs.4146
Ballantyne, G.H. (1983). Intestinal suturing. Review of the experimental foundations for traditional doctrines. Dis. Colon Rectum., 26 (12), 836-843. doi.org/10.1007/BF02554767
Pasic, F. & Salkic, N.N. (2013). Predictive score for anastomotic leakage after elective colorectal cancer surgery: a decision making tool for choice of protective measures. Surg. Endosc., 27, 3877-3882. doi: 10.1007/s00464-013-2997-1
Beard, J.D., Nicholson, M.L., Sayers, R.D., Lloyd, D. & Everson, N.W. (1990). Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br. J. Surg., 77 (10), 1095-1097. doi.org/10.1002/bjs.1800771006
Hendriks, T. & Mastboom, W.J. (1990). Healing of experimental intestinal anastomoses. Parameters for repair. Review Dis. Colon Rectum., 33 (10), 891-901. https://doi.org/10.1007/BF02051930
Bosmans, J.W.A.M., Jongen, A.C.H.M., Bouvy, N.D. & Derikx, J.P.M. (2015). Colorectal anastomotic healing: why the biological processes that lead to anastomotic leakage should be revealed prior to conducting intervention studies. BMC Gastroenterology., 15, 180. doi:10.1186/s12876-015-0410-3.
Paton, B.E. & Ivanova, O.M. (Eds.) (2009). Tkanevaya vysokochastotnaya elektrosvarochnaya khirurgiya [The live tissue’s high-frequency electric welding surgery]. Athlas. Kyiv: Naukova Dumka [in Russian].
Donskov, A.B., Donskov, A.B., Yesipov, V.K. & Kagan, I.I. (2011). Primeneniye mikrokhirurgicheskogo kishechnogo shva v usloviyakh peritonita pri povrezhdenii obodochnoy kishki [Application of microsurgical intestinal suture in conditions of peritonitis with damage to the colon]. Acta Biomedica Scientifica, (4-2), 234-236 [in Russian]. https://cyberleninka.ru/article/n/primenenie-mikrohirurgicheskogo-kishechnogo-shva-v-usloviyah-peritonita-pri-povrezhdenii-obodochnoy-kishki
Ho, Y.-H. & Ashour, M.A.T. (2010). Techniques for colorectal anastomosis. World J. Gastroenterol., 7, 16 (13), 1610-1621. doi: 10.3748/wjg.v16.i13.1610
Podpriatov, S.S., Podpriatov, S.E., Marinskyi, H.S., Chernets, O.V., Tkachenko, V.A., Byelousov, … Serdyuk, V.K. (2017). Modelne eksperymentalne doslidzhennia mekhanichnoi rezystentnosti stinky kyshky liudyny pid tyskom v prototypi elektrozvariuvalnoho instrumentu [Model experimental research of human intestine walls mechanical resistance under the pressure inside biologic welding instrument prototype]. Problemy viiskovoi okhorony zdorovia – Military Health Problems, (2), 325-331 [in Ukrainian].
Downloads
Published
Issue
Section
License
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
