Randomized trial on the application of biofragmentable anastomosis ring in intestinal anastomosis

Background The biofragmentable anastomosis ring （BAR） is a simple alternative device to create intestinal anastomosis. Our study was designed to evaluate the clinical value of BAR in intestinal anastomosis. Methods A total of 167 patients performed intestinal anastomosis from January 2002 to February 2006 were randomized to BAR group （n=82） and manual suture group （n=-85） as control. They were equally allocated to the two groups regarding sex, age, site of anastomosis, emergent or elective surgery and contaminant diseases. The results of postoperative complications and recovery were recorded in each group. Results Eighty-seven intraperitoneal BAR anastomoses were completed in 82 patients. Two and one postoperative deaths were recorded in BAR and suture group, respectively, no deaths were directly related to anastomotic technique. In suture group, anastomotic leakage and early bleeding both occurred in two patients respectively, no anastomotic bleeding occurred in BAR group, one patient in BAR group developed enterocutaneous fistulae. Perioperative bleeding, operation time and length of hospitalization were similar in two groups （P 〉0.05）. Time for return of bowel function was significantly shortened in BAR group than that in suture group （P 〈0.05）. Conclusion The BAR appears to be a standard, easy, safe and effective alternative either in elective or emergent intraperitoneal intestinal anastomotic surgery.

A Novel Rodent Model Modifying Perioperative Temperature and Humidity during Bowel Surgery and Mimicking Laparoscopic Conditions

Laparoscopic surgery seems to have a general physiological benefit compared to conventional procedures in several clincal studies especially regarding intestinal anastomotic healing. Reliable experimental data concerning the particular mode of beneficial action are lacking. Clinical studies will not be able to identify the variables responsible for this effect. To establish a feasible, standardized experimental model to investigate variables such as humidity and perioperative room temperature, we employed an incubator designed for neonatal care. This allows individual manipulation and observation of above mentioned variables. Our initial results show that creating intestinal anastomoses in the incubator is safe and easy to perform, creating a valuable possibility to influence perioperative conditions for experimental and clinical research.

Changes of the colonic physiologic functions after colonic anastomosis with a degradable stent in a porcine model

Background A new procedure of colonic anastomosis with a degradable stent has already been proven to be simple, feasible, and safe in our porcine model. In this study, we evaluated its impact on the colonic physiologic functions. Methods A total of 20 pigs were assigned randomly to either a stent anastomosis group （SA, n=10） or a conventional anastomosis group （CA, n=10）. Colonic anastomosis with a degradable stent was performed in the SA group, and conventional hand-sewn anastomosis was performed in the CA group. Body weight, fecal weight, total colonic transit time, immunohistochemistry staining of interstitial cells of Cajal （ICC）, plasma diamine oxidases （DAO） levels, and Western blotting analysis of occludin were evaluated before and after anastomosis. Results No obvious diarrhea or constipation was observed in all pigs. No significant difference in body weight between the groups was detected at any time. Yet, the fecal weight was less in the CA group compared with the SA group on postoperative day （POD） 7. No observable colonic paralysis or retention occurred. For total colonic transit time, there was no significant difference between the two groups at any time or among different time points in the same group. The integrated optical density of ICC showed no significant difference on either POD 14 or 30. The plasma DAO levels were remarkably elevated after surgery, and began to decrease since POD 3. However, there was no significant difference between both two groups in plasma DAO levels at any time either. For both groups, the expression of occludin was not significantly different from their pre-surgery level on either POD 14 or 30. Conclusions According to these results, this procedure with a degradable stent was supposed to be the same as the conventional hand-sewn procedure in their impact on the colonic physiologic functions.

40years’ review of intestinal atresia

Objective To analyze the 40 years' experience of intestinal atresia and to introduce a new design of longoblique anastomosis for disproportional loop s of the intestine Methods A total of 449 cases of congenital atresia of the small intesti ne were classified into three groups according to the embryopathology: high grou p (145 cases), including duodenal and high jejunal atresia; middle group (288), including ileojejunal atresia; and low group (16), including terminal ileal at resia To analyze the survival rate and mode of treatment, we assigned the cases into 3 gr oups according to the year of admission: 1) 1956-1969 (173 cases), under the gen eral pediatric surgical care; 2) 1970-1985 (147), under the specialty neonatal s urgical care; and 3) 1986-1996 (129), with additional use of total parenteral nu trition Results The ileojejunal atresia group (middle group) had the highest m ortality rate (476%) The overall mortality rate decreased as the time went b y, dropping from 647% in the early years down to 186% in the recent years, a nd no hospital death occurred in the recent couple of years Conclusion Besides the improvement of neonatal surgical techniques, sel ecting a proper surgical procedure according to the embryopathology is essential to the r eduction of mortality The longoblique anastomosis is particularly acceptable in China at present for marked disproportional loops