Intestinal Anastomosis Research Articles

The effect of circular stapler size on anastomotic stricture formation in colorectal surgery: A propensity score matched study.

Small circular staplers possess the advantage of being relatively easy to use when compared to larger circular staplers. However, there is some contention as to whether the use of small circular staples in colorectal surgery increases the incidence of anastomotic strictures. This study aimed to determine whether the frequency of anastomosis site stricture formation differs depending on stapler size when performing anastomosis in colorectal surgery. Patients who underwent surgery for colon or rectal disease between June 1, 2009, and December 31, 2021, and who had circular staplers used for the formation of intestinal anastomoses post colectomy were included in our study. Propensity score matching with a 1:1 ratio using logistic regression was performed. The primary outcome was the anastomotic stricture rate, and the secondary outcome was total anastomotic complications. A total of 875 patients who were operated on by surgeons using 28/29-mm and 25-mm circular staplers were included. After propensity score matching, 106 patients were assigned to each group. Anastomotic strictures occurred in two cases (1.9%) from the 25-mm group and in four cases (3.8%) from the 28/29-mm group. There were no statistically significant differences between the two groups (p = 0.683). Anastomotic complications were observed in two cases (1.9%) from the 25-mm group and in six cases (5.7%) from the 28/29-mm group; no statistically significant differences were found (p = 0.280). Circular stapler size does not influence anastomotic stricture formation in colorectal surgery.

Intestinal anastomoses in children: Experience of pediatric surgeons in the Russian Federation

BACKGROUND: In pediatric surgery, intestinal anastomosis is a standard and responsible operative method used for all age groups. Although advancements in medical technology have significantly changed and expanded the range of surgical interventions, many questions remain, including the safety of intestinal anastomosis in newborns with significant segment discordance, the use of laparoscopic intestinal sutures, the use of mechanical stitching devices, and intestinal anastomosis in peritonitis.
 AIM: To determine current problems and future directions in the field of intestinal anastomosis in children in the Russian Federation.
 MATERIALS AND METHODS: The study is based on data from 4,558 intestinal anastomosis operations, including 1,735 in newborns, provided by the chief pediatric surgeons of 75 constituent entities of the Russian Federation during 20212022, including the Donetsk and Lugansk Peoples Republics. Based on a questionnaire, the data were summarized and statistically processed.
 RESULTS: The study reports on the results of intestinal anastomosis in children in the Russian Federation across various segments of the intestine and age groups. The risks of failure and re-reconstruction significantly increased when duodenal anastomosis was performed laparoscopically and in settings of peritonitis or a compromised intestinal wall (p 0.05). Conversely, the use of laparoscopy and suturing devices in older children for small intestine anastomosis was carried out practically without complications. However, it was performed twice as often in emergencies and against the background of combined problems. In general, the results of small bowel anastomosis under poor conditions were statistically insignificant from intestinal anastomosis with stoma closure (p 0.05). The data revealed that colon surgery, repeated reconstructions, duodenal anastomoses, and small intestine anastomoses in newborns with poor blood flow to the intestinal wall posed the highest risks of anastomotic failure. Small and large intestine surgery in newborns has the highest mortality rate, particularly with peritonitis and circulatory disorders.
 CONCLUSIONS: Thus at the current stage of development, intestinal anastomosis in the Russian Federation is characterized by good results, the expansion of indications for anastomosis in conditions of compromised intestine or peritonitis, and the use of laparoscopic techniques and mechanical staplers.

Gastrointestinal thickness, duration, and leak pressure of five intestinal anastomosis techniques in cats.

To compare time to construct completion and resistance to leakage for five intestinal anastomosis techniques in cats and to report normal feline gastrointestinal thickness. Experimental study. Grossly normal intestinal segments (n = 120) from 10 fresh cat cadavers. A total of 8 cm segments of fresh feline cadaveric intestine were collected, and mural thickness was recorded. Segments were randomly allocated between a control group (n = 20 segments) and five treatment groups (20 segments/group with 2 segments/construct = 10 constructs per group): (1) hand-sewn anastomosis - simple interrupted (HSA-SI), (2) hand-sewn anastomosis - simple continuous (HSA-SC), (3) functional end-to-end stapled anastomosis (FEESA), (4) functional end-to-end stapled anastomosis with oversew (FEESA-O), (5) skin stapled anastomosis (SS). Time to construct completion, leakage location, initial leak pressure (ILP), and maximum intraluminal pressure (MIP) were compared. Mean mural thickness ± SD (mm) for the stomach, duodenum, jejunum, and ileum were 1.66 ± 0.28, 2.05 ± 0.18, 2.28 ± 0.30, and 2.11 ± 0.39, respectively. ILPs (mean ± SD) for HSA-SI (165 ± 122 mmHg), HSA-SC (149 ± 83), FEESA-O (63 ± 25, FEESA (84 ± 59), SS (77 ± 56), and control segments (>500) were compared. There was no statistically significant difference in ILP (p > .08) or MIP (p > .084) between any treatment groups. Nonoversewn FEESAs were 2.4 times faster to perform compared to oversewn FEESA and SS groups, and 4.7 times faster than HSA (p < .001). All anastomosis techniques provide resistance to leakage that is supraphysiological to that of the normal maximum intraluminal pressure. HSA take longer to complete than stapled anastomoses. All anastomotic techniques may be appropriate in cats. Hand-sewn anastomoses result in a longer surgical time.

Dye-free visualisation of intestinal perfusion using laser speckle contrast imaging in laparoscopic surgery: a prospective, observational multi-centre study

IntroductionIntraoperative perfusion imaging may help the surgeon in creating the intestinal anastomoses in optimally perfused tissue. Laser speckle contrast imaging (LSCI) is such a perfusion visualisation technique that is characterized by dye-free, real-time and continuous imaging. Our aim is to validate the use of a novel, dye-free visualization tool to detect perfusion deficits using laparoscopic LSCI.MethodsIn this multi-centre study, a total of 64 patients were imaged using the laparoscopic laser speckle contrast imager. Post-operatively, surgeons were questioned if the additional visual feedback would have led to a change in clinical decision-making.ResultsThis study suggests that the laparoscopic laser speckle contrast imager PerfusiX-Imaging is able to image colonic perfusion. All images were clear and easy to interpret for the surgeon. The device is non-disruptive of the surgical procedure with an average added surgical time of 2.5 min and no change in surgical equipment. The potential added clinical value is accentuated by the 17% of operating surgeons indicating a change in anastomosis location. Further assessment and analysis of both white light and PerfusiX perfusion images by non-involved, non-operating surgeons showed an overall agreement of 80%.ConclusionPerfusiX-Imaging is a suitable laparoscopic perfusion imaging system for colon surgery that can visualize perfusion in real-time with no change in surgical equipment. The additional visual feedback could help guide the surgeons in placing the anastomosis at the most optimal site.

Single-Layer or Double-Layer Intestinal Anastomosis: A Systematic Review of Randomized Controlled Trials.

Several malignant and benign indications may necessitate bowel resection. Despite the emergence of newer techniques, the hand-sewn technique remains popular for the reestablishment of intestinal continuity after resection. This method can achieve anastomosis in one or two layers. Some studies have suggested that the single-layer technique has several potential benefits compared to its rivals while simultaneously maintaining a comparable efficacy and safety profile. Previous reviews have failed to recommend either of these methods over the other due to a lack of high-quality evidence. This review aims to establish which technique provides the best outcomes by reviewing recent relevant trials and comparing both methods. We conducted a systematic review of randomized controlled trials (RCTs) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A database search of PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) ultimately returned nine randomized trials published between 2003 and 2023 comparing single-layer intestinal anastomosis (SLIA) and double-layer intestinal anastomosis (DLIA) that fit the inclusion criteria. Overall, results show a dearth of robust trials, and the included studies displayed variable eligibility criteria and materials used for anastomosis. The available evidence, however, does suggest that neither technique is inferior in terms of preventing post-operative complications, but SLIA is less expensive and quicker to perform. The evidence is, however, limited, and further high-quality research is needed.

Double-Layered Hand-Sewn versus Stapled Intestinal Anastomosis in Patients Who Underwent Ileal Urinary Diversion in Radical Cystectomy: A Comparative and Cost Effective Study

Introduction: Intestinal anastomosis can be performed by hand suturing (single layer or double layer) or by a mechanical suturing machine. The aim of the study was to compare complications, operative time, and costs of the intestinal anastomosis techniques. Methods: A retrospective comparative study was conducted including patients who underwent radical cystectomy and uretero-ileo-cutaneostomy or vescica ileale Padovana orthotopic neobladder. Double-layered hand-sewn intestinal anastomosis (HS-IA) were performed using Vicryl stitches. Mechanical-stapled intestinal anastomosis (MS-IA) were performed with a mechanical stapler. Results: Data of 195 patients who underwent were collected. 100 (51.3%) patients underwent HS-IA and 95 (48.7%) patients underwent MS-IA. Considering the complications classified according to Clavien-Dindo, a statistical difference with higher incidence for grade one in the HS-IA both in the ileal conduit group and in the neobladder one than the MS-IA (15.8% and 8.7%, respectively, in HS-IA vs. 1.7% and none in MS-IA). There is not a significant difference in time to flatus and time to defecation. Difference is recorded in the ileal conduit groups for the length of stay (10 days, range 9–12 with HS-IA vs. 13 days range 12–16 days with MS-IA (p < 0.001). The cost of the suture thread used for a single operation was 0.40 euros, whereas the overall cost of a disposable mechanical stapler and one refill was 350.00 €. Conclusion: Both HS-IA and MS-IA are safe and effective for patients. The cost for the stapling device is 350 €, in contrast, the cost for Vicryl sutures is negligible.

The Role of Adipose Tissue Mesenchymal Stem Cells in Colonic Anastomosis Healing in Inflammatory Bowel Disease: Experimental Study in Rats.

(1) Background: A surgical operation on an inflamed bowel is, diachronically, a challenge for the surgeon, especially for patients with inflammatory bowel disease. Adipose tissue-derived mesenchymal stromal cells are already in use in clinical settings for their anti-inflammatory properties. The rationale of the current study was to use AdMSCs in high-risk anastomoses to monitor if they attenuate inflammation and prevent anastomotic leak. (2) Methods: a total of 4 groups of rats were subjected to a surgical transection of the large intestine and primary anastomosis. In two groups, DSS 5% was administered for 7 days prior to the procedure, to induce acute intestinal inflammation. After the anastomosis, 5 × 106 autologous AdMSCs or an acellular solution was injected locally. Macroscopic evaluation, bursting pressure, hydroxyproline, and inflammatory cytokine expression were the parameters measured on the 8th post-operative day. (3) Results: Significantly less intra-abdominal complications, higher bursting pressures, and a decrease in pro-inflammatory markers were found in the groups that received AdMSCs. No difference in VEGF expression was observed on the 8th post-operative day. (4) Conclusions: AdMSCs attenuate inflammation in cases of acutely inflamed anastomosis.

Determination of the optimal reconstruction for pancreaticoduodenal resection based on modified scintigraphy of gastrointestinal motility

Aim. To improve the outcomes of pancreaticoduodenal resection by determining the optimal reconstruction based on objective assessment of the functional state of the upper gastrointestinal tract using a modified “double” scintigraphic study.Materials and methods. 147 pancreaticoduodenal resections were performed in the period of 2016–2022. Patients underwent “double” scintigraphic study on days 30 and 90 after surgery. The mean age of the patients was 59.6 years (23–83); the male to female ratio was 1.27:1. All patients underwent gastropancreatoduodenal resection or pancreatoduodenal resection with pylorus preservation. The patients were divided into 3 groups according to the variant of the reconstructive stage of surgery. Group 1 underwent reconstruction according to Child, group 2 – Child reconstruction and interintestinal anastomosis formation according to Brown, the reconstructive stage in group 3 involved Roux-en-Y isolation of the small intestine (Roux-en-Y reconstruction).Results. “Double” scintigraphic study revealed that the best result on the 30th and 90th postoperative days was observed in patients who underwent pancreaticoduodenal resection with pylorus preservation, reconstructive stage according to Child and formation of interintestinal anastomosis after Brown.Conclusion. “Double” scintigraphy is an effective procedure to determine the motility of the stomach, biliodigestive anastomosis and motility of the small intestine. As a result, the optimal reconstruction after pancreaticoduodenal resection was determined in patients with neoplasms of the pancreatic head or the periampullary region and chronic pancreatitis.

Adenomyoma of the small intestine in children: a 12-year experience in a tertiary referral center.

Adenomyoma of the small intestine is rare in children and the clinical characteristics is not clear. The study was to document the clinical characteristics and treatment of children with adenomyoma of the small intestine. A retrospective study was conducted in children with intestinal adenomyoma from 2010 to 2022. We recorded age, gender, symptoms, location, tumour size and treatment options. Thirteen patients with adenomyoma of the small bowel were included. The median age was 20 months with a male-to-female ratio of 10:3 and more than half of the patients were younger than 2 years old. The mean tumour size was 2.0 cm. The lesion was found accidentally in one patient, and the others presented with symptoms of intussusception. A pathological lead point was found on ultrasound in seven patients. All tumours were located in the ileum, ranging from 24 to 260 cm proximal to the ileocecal valve. The tumour was found in an antimesenteric site in eight patients. Three patients suffered intestinal necrosis, and segmental resection of the ileum was performed. Three patients without intestinal necrosis underwent tumour rection, while intestinal resection and anastomosis were performed in the remaining seven. All patients recovered well except one, who developed intussusception 7 days after surgery; that patient underwent surgery and recovered uneventfully. Adenomyoma of the small intestine has a male predominance in children and intussusception is a common presentation. The ultrasound feature is a mass of mixed echogenicity containing several small cystic areas. Surgery is the primary treatment option and the procedure should be chosen based on intraoperative findings.

C‐reactive protein as an early predictor of anastomotic dehiscence in various types of reconstruction in elective abdominal surgery

AbstractObjectiveThe most important factor in abdominal surgery is the successful healing of the intestinal anastomosis performed. This study aims to evaluate the role of C‐reactive protein (CRP) in predicting anastomotic dehiscence in the first week following surgery.MethodsThe study included 100 patients surgically treated over a period of 1 year. Postoperative (p/o) values of CRP, leukocyte (white blood cells [WBCs]) and body temperature (BT) were measured in relation to the development of p/o complications.ResultsCRP p/o values were significantly higher in patients with complications and proved helpful in predicting p/o complications, while WBC and BT were not. For the development of anastomotic leakage, receiver operating characteristic curve shows the earliest diagnostic accuracy on the third p/o day with the cut‐off value of 115.1 mg/L; however, the largest area under the curve was on the fifth p/o day with a cut‐off value of 59.2 mg/L, a sensitivity of 89%, a specificity of 61%, a positive predictive value (PPV) of 21.9 and a negative predictive value (NPV) of 100.ConclusionsMeasurement of p/o CRP values may indicate problematic healing of digestive tract anastomosis before the appearance of clinical signs. High sensitivity and high NPV allow us to rule out p/o complications and anastomotic dehiscence with great certainty and safely discharge these patients from the hospital.

Free jejunum transfers in oncologic reconstruction

Methods of pharyngoesophageal reconstruction include gastric pull-up, colon or jejunal interposition, and transfer of a free anterolateral thigh flap. The most popular method at our institution is transfer of a free jejunal graft. The free jejunum transfer was first described in 1957 by Seidenberg. The advantage of this procedure is a decreased risk of fistula, because the pharyngoesophagus is physiologically reconstructed with bowel-type reconstruction material. There are few reports about the operative methods of free jejunum transfer in detail and the operative methods vary greatly by institution. We performed free jejunum transfers for several hundred patients in the past and reported the characteristics and intraoperative and postoperative matters that require attention. Here, we summarize free jejunum transfer in oncologic reconstruction with relation to the points of safety, recipient vessels and microsurgical anastomosis, intestinal anastomosis and postoperative complications based on our experience and published reports.

Early versus Delayed Enteral Nutrition after Gastrointestinal Anastomosis in Children: A Systematic Review and Meta-Analysis

Abstract Background Elective intestinal anastomosis is a frequently used surgical procedure in pediatric surgery. This option is used to restore intestinal continuity (ileostomy or colostomy closure), resolve an inflammatory disease or functional or anatomic congenital malformation. It is a common practice to avoid oral feeding in children after intestinal anastomosis surgery, traditionally from 3-5 days. Recently, interest has increased in the concept of early enteral nutrition (EEN) in abdominal surgery in adults, but it needs further research in children. Aim of the Work The aim of this study is to determine whether early enteral nutrition following elective gastrointestinal anastomosis surgery in children leads to improved patient outcome measures and to assess whether this practice increases the risk of postoperative complications, according to literature published in the period from 2010- 2020 Patients and Methods We searched PubMed, Cochrane, Embase, Google scholar, Egyptian Knowledge Bank including Science Direct, Scopus and Web of Science. Data from 2010 – 2020 were obtained using the following Medical Subject Headings (MeSH) terms. For the early aspect of nutrition, we used the MeSH terms ‘‘early’’ or ‘‘enhanced recovery’’ and ‘‘enteral nutrition’’ or ‘‘feeding’’. For the surgical background, we used the MeSH terms ‘‘gastrointestinal’’ or ‘‘bowel/intestinal’’ or ‘‘colorectal’’ and ‘‘surgery’’ or ‘‘anastomosis’’ or ‘‘resection,’’ while for the population we used the terms ‘‘child’’ or ‘‘pediatric’’ or ‘‘infant’’. Multiple outcomes were used. The softwares Review Manager (RevMan 5.3, The Cochrane Collaboration) and STATA (Stata Corp. 2007) were used to analyse the data and formulate the results. Results Seven RCT studies met the inclusion criteria, comprising 278 cases with EEF and 323 cases with DEF. Enteral feeding started significantly earlier in the EEF group compared to the DEF group (MD = -69.43; 95% CI -72.20 to -66.65; p &amp;lt; 0.0001). The EEF group had an earlier time to first bowel movement (MD -18.18; 95% CI -27.04 to -9.32; p &amp;lt; 0.0001), an earlier time to full diet intake (MD -103.50; 95% CI -126.63 to -80.37; p &amp;lt; 0.00001) and a shorter length of hospital stay (MD -3.57; 95% CI -4.4 to -2.74; p &amp;lt; 0.00001). There was no significant difference in incidence of nausea and vomiting (OR = 1.36; 95% CI 0.56, 3.30; p = 0.5), abdominal distension (OR = 1.68; 95% CI 0.80, 3.53; p = 0.17) or anastomotic dehiscence (OR = 0.58; 95% CI 0.19, 1.75; p = 0.34) between groups. There was significant difference between groups in surgical site infection (OR = 0.27; 95% CI 0.13, 0.57; p = 0.0005) and fever (OR = 0.32; 95% CI 0.16, 0.61; p = 0.0007) in favour of EEN. Conclusion When early enteral nutrition was compared to traditional delayed feeding, results showed that EEN is safe and effective in pediatric patients undergoing elective intestinal anastomosis.

191 Minimally Invasive General Surgery Landmark Trials and Lessons Learned - A Narrative Review

Abstract Aims The aim of this review is to explore the history of minimally invasive (MI) surgery and landmark trials that guide modern practice. Methods A narrative review was conducted according to the four steps outlined by Demiris et al. Results MI surgery has become the gold-standard for many operations. Laparoscopic surgery has equivalent operative outcomes to open surgery with reduced recovery time and hospital stay. Randomised controlled trials (RCTs) investigating complex laparoscopic upper gastrointestinal oncological resections demonstrate reduced blood loss and postoperative pain. Within colorectal surgery, the CLASSIC and COREAN trials described comparable mortality and oncological clearance in MI colorectal cancer resections versus open surgery. Conversely, ALaCaRT and ACOSOG raised concerns about oncological results. Robotic surgery provides a high degree of instrument freedom and stabilises hand tremors, however substantial associated costs remain a barrier. Robotic cholecystectomy (RC) is a safe and effective tool, and RC outcomes are comparable to laparoscopic surgery in the elective setting; although more evidence is required for more complex disease outcomes. For rectal cancer, the ROLARR trial found no difference in complications, conversion rate, or circumferential margin positivity for robotic-assisted versus laparoscopic surgery. Recently, the Smart Tissue Autonomous Robot performed the first autonomous intestinal anastomosis on porcupines, outperforming expert surgeons for both consistency and accuracy, demonstrating the potential future of robotic surgery. Conclusion This review gives an overview of MI general surgery; demonstrating the advantages as well as some concerns for the different surgical techniques, and raises suggestions for future uses.

Extra-abdominal Intestinal Anastomosis: A New Technique and Problem-solving Tool in Many Critical Circumstances

Background: Anastomosis leakage following intestinal anastomosis and the development of septic complications is a major problem for surgeons in certain clinical situations. There are many circumstances, where surgeons are in great trouble for decision making, where exteriorization of the intestine or performing a primary anastomosis is a risky procedure with a very fatal outcome. The purpose of this paper is to introduce a newer technique “extra-abdominal intestinal anastomosis”. Objective: The ultimate aim of this research is to assess the outcome of this new procedure compatible with such situations with different important surgical aspects. Methods: This prospective study was conducted with a total of 42 patients of extra-abdominal small intestinal done in Khulna Medical College Hospital (KMCH), Bangladesh. The study period was from January 2017 to November 2020. All the operations were done on emergency setup. Convenient purposive sampling was the sampling technique. Results: In this research, approximately 28.6% (12 patients) were undergone emergency operations for gangrenous intestine, followed by 19.0% (08 patients) for postoperative abdominal sepsis. Another important indication was strangulated hernia (07 patients, 11.9%). Extra-abdominal intestinal anastomosis on a trial basis was done in 42 patients in KMCH. Excellent results were observed. Overall mortality and morbidity have been reduced. Moreover, due to fewer complications, hospital stays, and costs have been reduced, on the contrary, patient compliance has been increased. The mortality rate with extra-abdominal intestinal anastomosis was 14.3%, whereas it was reported to be very high previously in KMCH in many circumstances. Extra-intestinal leakage was observed in approximately 26.2% of cases. Approximately in 14.3% patients of with extra-abdominal leakage, extra-abdominal repair was possible without major consequences. Early internalization of the intestinal anastomosis with the closure of the abdominal wall was possible on the 7th to 14th postoperative day in approximately 61.9% of patients with good results. Conclusion: The newer method, extra-abdominal intestinal anastomosis is a resilient procedure in many emergencies with fewer complications, less hospital staying, reduced mortality, morbidity rate and excellent patient compliance. Mediscope 2023;10(2): 56-62

Spontaneous closure of transverse loop colostomy: A case report

Colostomy is an artificial colo-cutaneous fistula which can be temporary or permanent, depending on the purpose for which it was created. The indications for colostomy include protection of a distal intestinal anastomosis, control of sepsis in open injury to the colon or rectum, to facilitate the operative treatment of a high anal fistula

The comparison of anastomosis strength and leakage between double-layer full-thickness and single-layer extramucosal intestine anastomosis.

This experimental study was performed in 20 randomized healthy male pigs, to be included either in Group A (Single-layer extramucosal intestine anastomosis) or Group B (Double-layer full-thickness intestine anastomosis). Enterotomy followed by an end-to-end anastomosis suture was performed in the jejunum. Fourteen days after the operation, any anastomosis leakage and its location was documented. The anastomosis strength was evaluated using manometry. Data were compared between groups using the Mann-Whitney U and Fischer Exact test, considering a significance level of P<0.05. The overall mean intraluminal anastomotic bursting pressure was 4,257±1,185. Group A had a higher intraluminal anastomotic bursting pressure but was not statistically significant compared to group B (4.726±0.952 vs. 3.787±1.252 kilopascals, P=0.063). One leakage (5%, antimesenteric area) occurred in Group A and three leakages (15%, antimesenteric and mesenteric area) occurred in Group B. However, statistical analysis with Fischer exact showed no significant difference of leakage rate between those groups (P=0.291). The anastomosis strength and leakage did not differ significantly between the single-layer extramucosal intestine anastomosis group and the double-layer full-thickness anastomosis group. However, the location of leakage was most common in the antimesenteric area in the double-layer full-thickness anastomosis group.

Should primary anastomosis be considered more? A retrospective analysis of anastomotic complications in young children

ObjectiveLittle is known about intestinal anastomotic leakage and stenosis in young children (≤3 years of age). The purpose of this study is to answer the following questions: (1) what is...

Evaluation of the outcome of linear stapler anastomosis in comparison to hand-sewn anastomosis in elective loop transverse colostomy closure in children: a study in a tertiary care hospital, Dhaka, Bangladesh

Background: Conventional hand suture technique of intestinal anastomosis has been in vogue for decades. Staplers which developed to simplify surgery began to have significant impact. Objective were to see outcome of linear stapler anastomosis in comparison to hand-sewn anastomosis in elective loop transverse colostomy closure in children. Methods: This prospective interventional study was carried out in the department of pediatric surgery, Dhaka medical college hospital, Dhaka from January 2018 to December 2019 over a period of 2 years. Forty-seven patients who underwent loop transverse colostomy closure were included in this study. Patients were allocated by purposive sampling into two groups, group A (linear stapler anastomosis) and group B (hand-sewn anastomosis). Results: Mean age of the patients were 5.79±3.23 years and 4.21±3.13 years in linear stapler anastomosis group and hand-sewn anastomosis group respectively. Male to female ratio was 1.2:1 in linear stapler anastomosis group and 5.25:1 in hand-sewn anastomosis group. The mean duration of return of bowel movements (passage of flatus after surgery) in linear stapler method was 32.82±6.04 hours and in hand sewn method was 40.56±5.35 hours (p&lt;0.05). Oral feeding was started earlier in patients who underwent linear stapler anastomosis (3.18±0.39 days), as compared to hand-sewn anastomosis (4.16±0.37 days) (p≤0.001). The mean cost in linear stapler method was Tk. 4072±158 and in hand sewn method was Tk. 1440±362. Anastomotic leakage was lower (4.5%) in linear stapler anastomosis than that in hand-sewn anastomosis (20.0%) (p&gt;0.05). Conclusions: Stapling technique can be used safely and effectively as a part of modern Surgeon`s armory and one should be equally expert with stapler guns as with needle holders and sutures.

Assessment of laparoscopic intracorporeal intestinal anastomosis training using simulation-based 3D printed models: exploring surgical performance and learning curves.

Intestinal anastomosis is a clinical procedure widely used to reconstruct the digestive tract, but authentic laparoscopic intracorporeal intestinal anastomosis（LIIA） models are lacking. However, three-dimensional (3D) printing can enable authentic and reusable models. In this paper, a novel cost-effective 3D-printing training model of LIIA is designed and the authenticity and validity of the model are tested. An FDM 3D printing and assembled lab model were built to test LIIA. Fifteen surgeons were required to perform LIIA, and their operation score and time were recorded and analyzed. Five experts were invited to assess the face and content validity of the models. A study was also performed to further evaluate and validate the learning curve of surgeons. The difference in Modified anastomosis objective structured assessment of technical skills (MAOSATS) scores between the expert, intermediate and novice groups were significant (64.1±1.8: 48.5±1.7: 29.5±3.1, P < 0.001). In addition, the operation time of the procedure was statistically different for all three groups (21.5±1.9: 30.6±2.8:70.7±4.0, P < 0.001). The five experts rated the face and content validity of the model very highly, with the median being four out of five. Surgeons who underwent repeated training program showed improved surgical performance. After eight training, the novices' performance was similar to that of the average level of untrained intermediates, while the operation scores of the intermediates were close to that of the average level of experts. In this study, it is found that the LIIA model exhibits excellent face, content and construct validity, repeated simulation training of the LIIA training program improved the surgeon's operative performance, so the model is considered one of the effective methods for LIIA training and assessment of surgical quality in the future and for reducing healthcare costs.

Morphological features of bordering zones with anastomosis during surgical correction of congenital intestinal obstruction

Introduction. Despite the numerous studies carried out to improve the technique for abdominal operations using new suture materials, stitching technologies and various types of intestinal sutures, the failure of intestinal anastomoses sutures remains a serious surgical problem in both adult and pediatric practice. The purpose of our study is a comparative analysis of the healing of the interintestinal fistula using various types of sutures in an experiment on animals (newborn rabbits). Materials and methods. The experiment was performed on 15 newborn rabbits with reproduction of a model of intestinal obstruction at the level of the ileum and the imposition of end-to-end small-intestinal anastomoses and de Lorimier-Harrison plication with interrupted and continuous sutures. 3 groups were formed: the imposition of a plication anastomosis using a single-row continuous suture (group I (n = 5)), an end-to-end anastomosis using a single-row continuous suture (group II (n = 5)), group III (n = 5) - end-to-end anastomosis with a single-row interrupted suture. With the help of modern morphological research methods, the degree of the infiltrative-destructive process in the peri-anastomosed areas has been studied. Results. It was found that when using all types of sutures in the areas surrounding the anastomosis (with an implicit advantage of a continuous suture), similar morphological changes were observed, indicating the remodeling of the mucous membrane (RM), low regenerative potential of the small intestine. Deeper degenerative changes in the small intestine SO were observed during the correction of intestinal obstruction using an interrupted suture. Conclusion. The use of a continuous suture (in some cases (3 out of 5) has some advantage over the interrupted suture in the form of a relative preservation of the proliferative compartment zone with the presence of highly specialized cells. Counting Paneth cells, as an indicator of the regenerative capabilities of the small intestine CO, is a promising and objective method for assessing the quality small bowel anastomosis.