Objective The effects of seromuscular layer anastomosis， extramucosal anastomosis，single-layer anastomosis and double-layer anastomosis of gastrointestinal tract on anastomotic healing were compared.
Methods Chinese rabbits were divided into four groups: group A (double-layer anastomosis, n=10), group B (single-layer inverted anastomosis, n=10), group C (extramucosal anastomosis, n=10) and group D (seromuscular layer anastomosis, n=10). Five anastomoses were performed in each animal: one side-to-side gastroduodenal anastomosis, two end-to-end ileal and colonic anastomoses respectively. Half of each group was sacrificed on postoperative day 3 and 7 respectively to determine in situ anastomostic bursting pressures (ABP) and hydroxyproline (HP) content, and to receive histopathologic examination. Inflammatory index and mucosal healing index of anastomosis were calculated.
Results There were no significant differences in case of ABP among the groups on day 3, and with the same result among group A, B and C on day 7 in gastroduodenal, ileoileal and colocolonic anastomoses. On day 7, the ABP of gastroduodenal anastomosis was dramatically higher in group D than group A and B (P＜0.05), the ABP of ileoileal anastomosis in group D was significantly increased compared with group A (P＜0.01), and the ABP of colocolonic anastomosis in group D was also higher than group A, B and C (P＜0.05). There was no statistical difference in HP content among the 4 groups in gastroduodenal and ileal anastomoses on day 3 (P gt;0.05), and in ileal and colonic anastomoses on day 7 (P gt;0.05). HP content was higher in group A than group B on day 3 in colonic anastomoses (P＜0.05), and it was also found to be higher in group D than group A on day 7 in gastroduodenal anastomosis (P＜0.025). Inflammatory reaction was not different among the 4 groups in gastroduodenal and ileoileal anastomoses on day 3, and the inflammatory indices of gastroduodenal and colocolonic anastomoses in all groups were similar on day 7. The inflammatory index of colocolonic anastomosis was signicantly increased in group A than group C on day 3 (P＜0.05), and that of ileoileal anastomosis in group A was higher than group D on day 7 (P＜0.05). The mucosal healing indices of anastomoses were not significantly different among the 4 groups on day 7.
Conclusion Seromuscular layer anastomosis of gastrointestinal tract is as safe as other hand-sewn anastomoses, but it is more convenient and simpler than others.
Citation：
HUANG Congyun,WANG Jiannan,PENG Shuyou,ZHANG Tao,LI BingJian,XU Li. Comparison of Seromuscular Layer Anastomosis， Extramucosal Anastomosis， Single-Layer Anastomosis and Double-Layer Anastomosis of Gastrointestinal Tract in Rabbits. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2007, 14(4): 432-436. doi:
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- 1. 黄从云, 彭淑牖. 胃肠道吻合沿革 [Ｊ] . 中华胃肠外科杂志, 2005； 8(6)∶545.
- 2. Leslie A, Steele RJ. The interrupted serosubmucosal anastomosis-still the gold standard [Ｊ] . Colorectal Dis， 2003; 5(4)∶362.
- 3. Kuzu MA, Koksoy C, Kale IT, et al. Reperfusion injury delays healing of intestinal anastomosis in a rat [Ｊ] . Am J Surg， 1998; 176(4)∶348.
- 4. 孔璐, 王继峰, 周子悦, 等. 碱解法测定组织羟脯氨酸的实验研究 [Ｊ] . 中国骨质疏松杂志, 2003； 9(4)∶319.
- 5. Polat C, Arikan Y, Vatansev C, et al. The effects of increased intraabdominal pressure on colonic anastomoses [Ｊ] . Surg Endosc， 2002; 16(9)∶1314.
- 6. Durmus M, Karaaslan E, Ozturk E, et al. The effects of single-dose dexamethasone on wound healing in rats [Ｊ] . Anesth Analg， 2003; 97(5)∶1377.
- 7. Witte MB, Barbul A. Repair of full-thickness bowel injury [Ｊ] . Crit Care Med， 2003; 31(8 Suppl)∶S538.
- 8. 黄从云, 彭淑牖. 肠道吻合愈合研究进展 [Ｊ] . 国外医学·外科学分册, 2005； 32(2)∶114.
- 9. Gottrup F. Oxygen, wound healing and the development of infection. Present status [Ｊ] . Eur J Surg， 2002; 168(5)∶260.
- 10. Houdart R, Lavergne A, Valleur P, et al. Vascular evolution of single-layer end-on colonic anastomosis. A microangiographic study of 180 anastomoses in the rat from two to 180 days [Ｊ] . Dis Colon Rectum， 1985; 28(7)∶475.
- 11. Jansen A, Becker AE, Brummelkamp WH, et al. The importance of the apposition of the submucosal intestinal layers for primary wound healing of intestinal anastomosis [Ｊ] . Surg Gynecol Obstet， 1981; 152(1)∶51.
- 12. Shikata S, Yamagishi H, Taji Y, et al. Single-versus two-layer intestinal anastomosis: a meta-analysis of randomized controlled trials [Ｊ] . BMC Surg, 2006； 6(1)∶2.
