Operation technique and healing process of telescopic ileocolostomy in dogs.

The healing process of telescopic anastomoses was found in an animal experiment with 12 mongrel dogs. After the division of vessels an ileal segment of different length was invaginated into the lumen of the colon using single-layer interrupted sutures. The following four groups were used: Group A (n = 3): end-to-side ileocolostomy, single-layer interrupted suture (invagination length: 0 mm), survival time: 21 days. Group B (n = 3): invagination length: 20 mm, survival time: 7 days. Group C (n = 3): invagination length: 10 mm, survival time: 21 days. Group D (n = 3): invagination length: 20 mm, survival time: 21 days. At the end of the above survival times the anastomosis area was removed. The bursting pressure was measured and morphological as well as histological examinations were performed. In each case the 0-day look-alikes of anastomoses were performed using the remnant bowels, and bursting pressure measurements were done on these models as well. Anastomosis leakage did not occur. The serosal layer of the intracolonic part of the ileum disappeared during the healing process. The free surface of the intracolonic ileal segment became covered by the sliding mucosa of the colon and the prolapsing mucosa of the ileum. The following could be concluded after the experiments: The inner pressure tolerance of a telescopic ileocolostomy promptly after preparation is better than in case of another single-layer anastomosis. This fact results in increased safety against leakage on the first postoperative days. The inner pressure tolerance of the telescopic ileocolostomy increases during the healing process and it does not depend on the length of the invaginated part (0 day-20 mm: 56 mmHg +/- 6, Group A: 252 +/- 39, Group B: 154 +/- 19, Group C: 249 +/- 20, Group D: 298 +/- 2). There is no difference in pressure tolerance between the telescopic and the end-to-side single-layer interrupted anastomoses after the healing process. The invaginated section within the lumen of the large intestine does not suffer ischaemic or any other kind of damage. This inexpensive and simple anastomosis technique could be useful in the veterinary surgical practice as well.

Telescopic esophageal anastomosis: operative technique, clinical experiences.

The authors reconstructed the continuity of the alimentary tract by performing telescopic esophagogastrostoma in 208 patients who underwent either esophageal resection or total gastrectomy. The substance of the telescopic technique is to invaginate the distal section of any oral tubular organ to the lumen of an aboral tubular one and to fix it there. In case of telescopic esophageal anastomosis a 10-15 mm long esophageal segment is invaginated into the gastric tube or jejunum. A 3-4 mm wide serosal surface of the wall of the distal anastomosing organ straps the esophagus circularly. Ninety-six transthoracic and 12 transhiatal esophagectomies, 19 partial esophageal resections, four esophageal bypasses, and 77 total or extended total gastrectomies were reconstructed using telescopic anastomosis. Undisturbed healing could be observed in 67 patients after esophageal operations and in 46 patients of total gastrectomies. Anastomosis leakage occurred in 12 of 108 patients (11.1%) after cervical esophagogastrostomy. Leakage could be observed in 7 of 44 patients (15.9%) after end to side and in 5 of 64 patients (7.8%) in case of end to end esophago gastrostoma. There were no failures after two cases of cervical esophago-ileocolostoma and 21 of esophagogastrostomas in the thoracic position. All of the 59 intra-abdominal anastomoses healed without complication. Thirteen of 131 patients (9.9%) died after esophageal operations and four of 77 (5.2%) after gastrectomies. There were no mortal complications due to anastomotic leakage. The telescopic anastomosis is a safe alternative method in cases of total gastrectomy or esophageal operation.

Experimental examination of the healing process of telescopic esophageal anastomosis.

The basis of telescopic anastomosis is old, only the practical details of it have changed and improved. The telescopic anastomosis technique is successfully applied in our practice for reconstruction of gastrectomy and esophageal resection. The reason for this study was that data about the healing process of telescopic anastomosis had not been found in the literature. We used four groups of mongrel dogs for our experiments: Group A (n = 3) received 20 mm-long invaginations with a survival time of 7 days; Group B (n = 3) received 10 mm-long invaginations with a survival time of 21 days; Group C (n = 3) received 20 mm-long invaginations with a survival time of 21 days; Group D (n = 3) received 30 mm-long invaginations with a survival time of 21 days. At the end of the above survival times we removed the anastomosing area, measured the bursting pressures and performed morphological and histological examinations. In each case we also performed an anastomosis exactly the same as a completely healed anastomosis and its pressure tolerance was measured (0 day). The pressure tolerance within the anastomosis rises gradually and independently of the length of the invaginated esophageal part. Anastomosis leakage did not occur. The invaginated esophageal part did not suffer any damage. The muscular wall of the intragastric part of the esophagus became covered by the mucosa of the stomach during the healing process and it joined with the esophageal mucosa at the edge of the free end of the esophagus.

[Experiences with an Invagination Technique for Esophagogastric End-to-End Anastomoses]. / Erfahrungen mit der Invaginationstechnik bei ösophago-gastrischen End-zu-End- Anastomosen.

80 patients with esophageal cancer underwent esophagectomy with the stomach as an esophageal substitute. For end-to-end esophagogastrostomy an invagination technique was used. We describe the technique and the results. An anastomotic leak was observed in 5 of 80 patients (6.3 %) in the total, in 5 of 64 cases with cervical anastomosis (7.8 %) and in none of the 16 patients with thoracic anastomosis. 6 of 80 patients (6.5 %) died, 5 due to nonsurgical complications and one patient due to a necrosis of the esophageal substitute. On the basis of these results we recommend the described anastomotic technique due to its simplicity and low anastomotic leakage rate.

[Data about the early physical reliability of hand-sewn anastomoses in esophagectomy and gastrectomy]. / Adatok a nyelócsó és a gyomor reszekciós mútéteinél kézzel varrt anasztomózisok korai fizikai varratbiztonságához.

We examined on models the inner pressure tolerance of the most frequently performed single layer anastomoses used in esophagectomies and gastrectomies. The aim was to examine whether interrupted or continuous suture proves safer immediately after the operation. We investigated the difference between sutures involving and not involving the mucosa. The anastomosis models were of organs of hybrid pigs slaughtered in the meet-industry. Atraumatic, 3/0 Biosyn suture material was used. The bursting pressure was measured by insufflating CO2 gas. Its bursting pressure can characterize the inner pressure tolerance of an anastomosis. The circumstances of the experiment, the suture technique and the examination of the bursting pressure were standardized. Our considerations are: 1. The early inner pressure tolerance of an anastomosis does not depend on the condition of the wall. The critical factor is their ability to expand. 2. The inner pressure tolerance of continuous sutures is better than of interrupted ones if the tissues in the suture line show similar degree of dilatation. Optimal conditions are achieved with end-to-end or side-to-side anastomoses of single organs (for example between small bowel and small bowel or colon and colon). 3. Involving the mucosa in the stitches has not influenced early physical suture certainty.

[Experimental model for the examination of inner pressure tolerance of telescopic anastomosis and other frequently performed anastomosis types of the esophagus]. / Nyelócsóvel készült süllyesztett és más gyakrabban alkalmazott anasztomózis változatok belsó nyomástúrésének vizsgálata modellkísérletekben.

We have good results with telescopic anastomosis technique in partial oesophagectomies and gastrectomies. As we could not find data about the healing process of telescopic anastomoses so we started experimenting. Inside pressure tolerance was examined immediately after performing anastomoses by measuring the bursting pressure using the organs of pigs slaughtered in the meat industry. Both oesophago-gastrostomies and oesophago-jejunostomies were performed with telescopic, single layer interrupted, single layer continuous, double layer interrupted and double layer continuous-interrupted technique, 9 of each anastomosis. A series of oesophago-jejunostomies were performed with EEA stapler. 99 anastomoses of 11 types were investigated. We found, that the inner pressure tolerance of telescopic oesophago-gastrostomy is better than any other single layer type variant. On the other hand the double layer type variants have much better pressure tolerance than the telescopic and other two type single layer anastomoses. The difference is statistically significant. In oesophago-jejunostomies the pressure tolerance of telescopic anastomosis is better than of the single layer interrupted type but the difference between the telescopic and single layer continuous type anastomoses is not significant. The pressure tolerance of double layer anastomosis is higher than the telescopic one but the difference is significant only in the continuous-interrupted type. The inner pressure tolerance of telescopic and EEA stapler anastomoses are equal. The investigation of additional features in anastomosis healing is in progress.