Bowel anastomosis by inverting and everting techniques: An experimental study

Abstract

In this experimental study the surgical dictum that it is necessary to coapt serosa-to-serosa in order to obtain intestinal healing is challenged. A control group of large and small bowel anastomoses is compared with experimental groups in which direct submucosal apposition and everting techniques both by suture and nonsuture reapproximation of bowel are performed. Primary healing was obtained in all groups. Histologically a similar reaction was observed whether the anastomosis was by inversion, submucosal apposition, or everting techniques. Of significance was the low morbidity rate in the animals in which the bowel anastomoses were everted. The rate of morbidity is low probably because the intestinal lumen is not narrowed at the anastomotic site. From the results of this study Halsted's principle of including the submucosal layer in the bowel closure is much more important in intestinal healing than is Lembert's dictum of serosa-to-serosa approximation.