Direct comparison between Czerny-Lembert and circular-stapled anastomotic techniques in colorectal anastomosis: a similar pattern of healing for both.

Abstract

There are scant experimental data directly comparing the healing of the circular-stapled (CS) anastomotic technique with the standard Czerny-Lembert two-layer hand-sewn (HS) anastomotic technique during the acute and chronic phases of healing. The purpose of this study, therefore, was to serially evaluate wound healing in CS and HS anastomoses in the normal porcine colorectum. Forty-two adult female mixed-breed pigs randomly underwent either HS or CS anastomosis at the sacral promontory. Laser Doppler velocimetry (LDV), was used to measure perianastomotic blood flow. Groups of animals underwent a second surgery at 3, 5, 11, 60, or 120 days postoperatively, and anastomoses were restudied using LDV, gross and microscopic grading of inflammation, bursting pressures, and hydroxyproline content. Additionally, the 60-day and 120-day groups of animals underwent preoperative biplanar barium enemas to identify leaks or stenoses. No significant differences in perianastomotic blood flow between the HS and CS techniques were obtained over the entire 120-day study period. Serial evaluation of wound healing revealed no significant differences between the two anastomotic techniques with respect to bursting pressures, gross or microscopic inflammatory scores, or hydroxyproline content. There were no leaks or stenoses with either technique. Despite earlier reports to the contrary, there appears to be no fundamental difference in the mode of healing in the porcine colorectum comparing the HS technique with the CS technique.