Study on Randomized Clinical Trial Comparing Manual Suture and Different Models of Mechanical Suture in the Mimicking of Bariatric Surgery in Swine

Abstract

Background: Variations in surgeon ability provided as impetus for the invention of technologies that, by overcoming individual disparities, allow for proper execution of methods and the best potential end result. For a procedure to be adopted and recognised as effective, it must be reproduced consistently by the majority of surgeons.  Aims: The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb® 3-0 wire; group B, 80-shear linear stapler (Covidien® Gia 8038-S); group C, 75-shear linear stapler (Ethicon® Tlc 75); and group D, 75-shear linear stapler (Resource® Yq 75-3). Results: Observations during the histopathological analysis included the formation of foreign body granuloma in the gastroenteroanastomosis and enteroanastomosis in 88.9% of the swine that underwent manual suture and in none of the swine that underwent stapling. There was also a significant statistical difference among swine from Group A, and those from groups B, C and D regarding the degree of inflammation, being more intense in those swine that underwent manual suture. Although the results were not statistically significant, closing anastomoses in swine with mechanical sutures has the advantage of avoiding the need to breach the intestinal wall within the cavity, minimising the risk of peritoneal cavity contamination. Conclusion: This study shows that both types of suture promoted proper healing of gastroenteroanastomosis and enteroanastomosis, although there was a higher degree of inflammation and an increased occurrence of foreign body granuloma in swine subjected to manual suture, although there have been similarities in safety, efficiency, and effectiveness between the models of linear mechanical staplers tested during the performance of these anastomoses on swine.