RESUMO
UNLABELLED: The following animal study was undertaken to compare and assess the endoscopic gross appearance and histology of colonic anastomoses constructed with sutures, staples, and the biofragmentable anastomotic ring (BAR). METHODS: Three anastomoses--1 BAR, 1 stapled, and 1 sutured--were placed in each of 48 dogs and colonoscopy and anastomotic evaluation were done. RESULTS: No leaks were found by air insufflation at surgery. Grossly, the BAR had serosal hematomas in 27/48 anastomoses vs 7/48 for stapled and 1/48 for sutured (BAR vs stapled P < 0.0005 and sutured vs stapled P = 0.07). Adhesions were significantly greater for BAR (35/36) and sutured (34/36) compared to stapled (26/36) (BAR vs stapled P = 0.01 and sutured vs. stapled P = 0.04). Colonoscopic exams at days 3, 7, and 28 showed no significant difference among groups with respect to bleeding, ulceration, necrosis, granulation, or contour. Sutured anastomoses were more stenotic (24/31) than stapled (4/31) or BAR (3/31) ones (BAR vs sutured and sutured vs stapled P < 0.005). At 28 days, 10/10 sutured vs 2/10 stapled vs 3/10 BAR were stenotic (BAR vs sutured P = 0.02, sutured vs stapled P = 0.01). Inflammation on histologic exam at 28 days was not significantly different: sutured (12/12), stapled (12/12), or BAR (9/12). Fibrosis was more prominent in sutured (12/12) than in stapled (5/12) or BAR (4/12) anastomoses (BAR vs sutured P = 0.001, sutured vs stapled P = 0.004, and BAR vs stapled P = 1.00). All anastomoses healed primarily without necrosis or obstruction. CONCLUSIONS: (1) Colonoscopy to evaluate anastomoses can be done safely even in the early post-operative period. (2) The BAR anastomoses had the most serosal hematomas; BAR and sutured had more adhesions than stapled anastomoses; and sutured anastomoses had the most stenosis and fibrosis. None of these differences was of clinical significance.
