Alternativas de cierre de "muñón" rectal en la operación de Hartmann. Estudio experimental comparativo que incluye sutura mecánica reabsorbible (polisorb) / Alternatives for closure of the rectal

RESUMO

Five different kinds of sutures which can be used for closure of the rectal stump in Hartmann's operation are evaluated in the same animal. They are compared at six different phases of the cicatrization process 7-30-45-60-90 and 150 days. In the analysis, the degree of complete cicatrization is considered as well as the thickness of the cicatriced tissue, and other factors such as persistence of suture material and the result of it. All of the sutures involved accomplished the goal of a good joint of the planes of intestinal suture. Although, two of them, the metal stapler and Polyglactin (Vicryl) in extramucosal surgery fulfill almost in an ideal way the goals concerning security, rare reaction to suture material, and consequently less thickness in the cicatriced tissue (2 x 2 and 1 x 1 mm respectively) as well as complete cicatrization in ninety days. Stapler is performed quicker and in a more aseptic way, but the scar resulting from Polyglactin is smaller. In separate extramucosal points, silk produces a more important tissue reaction with a thicker scar (3 x 3 mm) coming to an end in 150 days. "Albert Lembert" type suture is really far away from being a good mean because it creates an important tissue reaction with a thick scar (3 x 3 mm), with late consolidation (150 days) and granulomatous reaction. Resorbable stapler--Polisorb--has a considerable volume and it causes an important tissue reaction which determines a very thick (4.5 x 4.5 mm) and "unfinished" scar within 150 days; really far away for practical use.