Low colorectal anastomoses

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Abstract
Extraperitoneal colorectal anastomoses were constructed in dogs by 4 methods: 1 layer of sutures (N = 10), 2 layers of sutures (N = 10), EEA staples (N = 10) and SPTC staples (N = 10). Dehiscence occurred in 8 sutured and 1 stapled anastomosis (P < 0.05). The 4 leaks following 2 layer sutured anastomoses caused 3 deaths, whereas all 4 leaks following 1 layer sutured anastomoses were only detected radiologically (P < 0.02). In the stapled group, the single leak followed EEA anastomosis and was fatal. Anastomotic narrowing was greater in sutured than stapled groups (P < 0.05). Two layers of sutures produced gross narrowing compared with 1 layer (P < 0.002). Two rows of staples (EEA) produced more narrowing than 1 row (SPTU) (P < 0.01). Mean hydroxyproline concentrations and bursting pressures on the 7th postoperative day were higher in stapled than sutured anastomoses (P < 0.05). Submucosal alignment, mucosal continuity, tissue viability and stage of healing were all inferior for 2-layer sutured anastomoses, reaching statistical significance for tissue viability (P < 0.05). Stapled anastomoses were completed significantly faster (32.6 .+-. 7.3 min) than sutured (54.1 .+-. 8.4 min) (P < 0.01). Stapling evidently is a fast and reliable method of colorectal anastomosis with a low complication rate. The shortcomings of the standard 2-layer sutured anastomosis are discussed.