Conventional Anastomosis Research Articles

An automatic sutureless coronary anastomotic device: initial results of an animal study.

The efficacy and long-term patency of a new distal anastomotic device (DAD) for the creation of rapid, sutureless end-to-side venous or arterial coronary artery bypass graft anastomoses were tested in a sheep model. The DAD was used on the beating hearts of 34 sheep to create 20 anastomoses between saphenous veins (n = 9) or internal mammary arteries (n = 11) and various coronary arteries. Fourteen conventional hand-sutured anastomoses (7 veins; 7 internal mammary arteries) served as controls. The sheep were sacrificed 1 day, 1 week, and 1, 3, and 6 months after surgery. The immediate patencies of all anastomoses were proven by the rates and pattern of flow. There were no significant differences between the DAD and suture anastomosis groups in presacrifice pulsatility index and occlusion rate. The histomorphometric studies showed complete intimal bridging over the DAD with no significant differences between DAD and suture anastomoses with respect to tissue response, mural injury, inflammation, and adventitial fibrosis. The DAD enables the creation of rapid, efficient, and sutureless venous or arterial coronary anastomoses. The long-term results of histomorphometric studies show that the results with the DAD are comparable with those of conventional hand-sutured anastomoses.

Cerebral revascularization.

During the last 10 years, there has been a revival of interest in cerebral revascularization procedures. Not only have significant progressions in surgical techniques been published, the use of more advanced diagnostic methods has led to a widening of the indications for cerebral bypass surgery. The purpose of this review is to outline the current techniques for extracranial-to-intracranial (EC/IC) and intracranial-to-intracranial (IC/IC) bypass surgery, as well as to identify the current indications for revascularization procedures based on the available literature. The excimer laser-assisted non-occlusive anastomosis (ELANA) technique is described in more detail because we think that this technique almost completely eliminates the risk of cerebral ischemia due to the temporary vessel occlusion which is currently used in conventional anastomosis techniques.

180 Degrees rotated intestinal anastomosis for jejunoileal atresia in neonates - a preliminary study.

The authors report the results of a preliminary study of a new technique of 180 degrees rotated anastomosis carried out as a primary anastomosis for ten neonates with jejunoileal atresia. The details of the technique are illustrated. The advantages of this technique over the conventional end-to-back anastomosis are discussed. A comparative analysis shows improved results compared to the conventional anastomosis.

Unconventional vessel wall apposition in off-pump porcine coronary artery bypass grafting: Low versus high graft flow

Objective: Facilitated coronary anastomosis techniques may involve unconventional vessel wall apposition in contrast to standard intima-intima apposition. We assessed the patency, anastomotic thrombus formation, and intimal hyperplasia of unconventional intima-adventitia apposition versus conventional suturing techniques in beating heart coronary bypass grafting under low versus high graft flow conditions. Methods: The intima-adventitia (n = 28) and conventional anastomoses (n = 28) were evaluated intraoperatively (n = 56), at 4 hours (n = 20), and at 5 weeks (n = 36) in a new off-pump low-flow (n = 28) and high-flow (n = 28) porcine bypass model (≤15 mL/min and about 60 mL/min, respectively). The anastomoses were assigned to the animals by means of randomized stratification and examined by means of flow measurements, angiography, and histology. Results: Mean graft flows in intima-adventitia and in conventional anastomoses were similar (P = .709). All but 1 of 56 anastomoses (low flow conventional) were fully patent at the time of death. At 4 hours, only small platelet depositions were found at the exposed media and adventitia in the unconventional anastomoses. At 5 weeks, little streamlining intimal hyperplasia was found, which was comparable between the anastomoses (P = .600). Conclusions: In low-flow conditions (≤15 mL/min) unconventional intima-adventitia apposition was not detrimental to the internal thoracic–coronary artery anastomosis in the pig. This finding may expand design strategies of facilitated coronary artery bypass anastomosis techniques.

End-to-end arterial anastomosis with fibrin glue in larger arteries: histology, hydroxyproline concentration and tensile strength study in carotids of rabbits

End-to-end conventional arterial anastomosis is time consuming, requires prolonged clamping times and is associated with focal necrosis, granulocyte infiltration and subsequently, fibrosis and calcification of the arterial wall. Fibrin glue as an alternative for microarterial anastomosis may obviate these lesions, with less adherence to adjacent tissues and better coaptation of the arterial margins. OBJECTIVE: In this study we compared the healing process of conventional to fibrin glue end-to-end anastomosis in larger arteries. METHODS: In 22 rabbits, both carotid arteries were cross sectioned and repaired by end-to-end anastomosis with 4 interrupted sutures and fibrin glue in one side (GI) and with 8 conventional interrupted sutures in the other side (G2). After 3 and 15 days, the animals were randomly allocated for tensile strength, hydroxyproline determination (8 animals), and histologic analysis of the anastomosis (3 animals). Conventional staining procedures (hematoxylin-eosin and Masson methods) and picrosirius red polarization (PSP) technique for collagen type determination were employed. RESULTS: From 3 to 15 days, the tensile strength increased in both groups, from 280.0± 32.6 g to 432.2± 131.2g in Group I and from 221.4± 72.4g to 452.2± 132.0g in Group 2 (p<0.001), with no statistical difference between the groups in each period of the study. The hydroxyproline content, expressed as hydroxyproline /protein ratio, varied from 0.0816 ± 0.0651 to 0.0622 ± 0.0184 in Group l and from 0.0734 ± 0.0577 to 0.0460 ± 0.0271 in Group 2, with no significant difference between periods and groups (p>0.05). Histology showed slight increase of inflammatory and reparative reactions in Group 2. PSP technique demonstrated predominant type I collagen in relation to type III collagen in the anastomosis of both groups, with no significant difference between them. CONCLUSION: Fibrin glue was less harmful to the arterial wall than conventional suture. Even using less sutures in fibrin glue anastomosis, similar tensile strength and healing characteristics were noted in both groups. Completion times for the fibrin glue group was significantly greater than for the conventional anastomosis.

Edge deepithelialization: A method to prevent leakage when tubed free skin flap is used for pharyngoesophageal reconstruction

Background. Anastomosis leakage remains a major source of morbidity and mortality in patients who receive pharyngoesophageal reconstruction, especially when a free skin flap is used as the substitute. This makes free skin flaps less favored than other substitutes in pharyngoesophageal reconstruction. However, a free skin flap provides many advantages for pharyngoesophageal reconstruction and, in some circumstances, may be the only choice. To reduce the incidence of postoperative leakage, we developed a technical modification called edge-deepithelialization for skin flap to ensure a more secure anastomosis. Methods. Twenty-four patients who received tubed free skin flaps for cervical esophagus or hypopharynx reconstruction during a 7-year period were included in this study. Group 1 (n = 12) received flap edge-deepithelialization before undergoing the anastomosis, and Group 2 (n = 12) received the conventional anastomosis method. Preoperative nutritional status was evaluated by serum albumin level. All the patients were followed up for at least 1 year (1 ~ 14 years; mean, 7.3 years). Postoperative leakage was detected by clinical symptoms and signs or by routine esophagography. Results. Postoperative anastomosis leakage developed in 1 patient in Group 1 (8.3%) and 5 patients in Group 2 (41.67%). The difference in the leakage rate between these groups was of statistical significance (P =.0001). There were no significant differences in the preoperative serum albumin level noted between these 2 groups (t test, P >.05). Older age was not associated with a higher leakage rate. Among the 6 leakage cases, 1 was treated conservatively, and the other 5 needed an additional 1 to 5 procedures for the management of leakage. All the leakages were cured during the follow-up period. Conclusions. With the flap edge deepithelialized, a more secure and reliable anastomosis can be obtained. This makes the free skin flap an easier and safer alternative in pharyngoesophageal reconstruction, especially when laparotomy and enteric flaps are contraindicated. (Surgery 2001;130:97-103.)

Eversion with four sutures: an easy, fast, and reliable technique for microvascular anastomosis.

In this study, a microvascular anastomosing technique called "eversion with four sutures" is introduced. For microvascular anastomosis, this technique requires fishmouth incisions at both vessel ends and the completion of four sutures. In 120 Wistar-Albino rats, 120 eversion and 120 conventional anastomoses were done in 240 femoral arteries. Each rat received both treatments. Operating time, bleeding time, number of sutures used, patency rates, and pseudoaneurysm formation were analyzed statistically; healing was evaluated with both light and electron microscopy. When compared with the conventional technique using nine sutures, the eversion with four sutures technique was found to be a faster and easier method of anastomosis and as reliable as the conventional technique. Without compromising patency rates, bleeding time, or rates of pseudoaneurysm formation, anastomosis time and amount of suture material exposed to the lumen were significantly reduced when using this technique. In conclusion, the authors think that eversion with four sutures is a reliable alternative to the conventional suturing technique, especially for emergency cases that require multiple microvascular anastomoses.

Gastrointestinal Anastomosis With Histoacryl Glue in Rats

Technical difficulties in creating gastrointestinal anastomosis in infants and young children, because of the small lumen, are well known and may be complicated by a narrow passage, anastomotic obstruction, gastric stasis, recurrent vomiting, and failure to gain weight. The search for alternative easier technique was the basis for this study. The primary aim was to evaluate the safety of anastomosis between the stomach and a loop of the jejunum performed by using the tissue adhesive Histoacryl glue in comparison with the same anastomosis performed conventionally with absorbable sutures. We compared the results of gastrojejunal anastomosis in rats using either Histoacryl (n-butyl cyanoacrylate) glue or continuous, absorbable sutures. Sixty-four Sprague-Dawley rats were divided into 4 groups of 16 rats each. Gastroenterostomy was performed with either type of anastomosis with and without truncal vagotomy. The criteria of gastroenterostomy investigated included anastomotic leakage, stricture formation, adhesion formation, and histological examination. The pH of gastric secretion was measured with intact gastric innervation and after vagotmy in all rats. The time to complete each type of anastomosis was measured in minutes. Anastomotic stricture, leak, peritonitis, and death happened in three rats in each group with intact vagal innervation, in two rats after vagotomy and anastomosis with Histoacryl, and in one rat after vagotomy and anastomosis with sutures. The results showed no statistically significant differences between the various groups, except the shorter time for performing the glued anastomosis (5-7 min) compared to the conventional anastomosis (16-21 min). In conclusion, gastroenterostomy with Histoacryl in rats appears to be as safe as conventional suture anastomosis, saves operating time, and is not affected by gastric acidity.

Sutureless end-to-end bowel anastomosis in rabbit using low-power CO(2) laser.

The use of laser energy to weld biological tissues and produce sutureless anasto mosis has its advantages over conventional silk-sutured anastomosis since it was reported in small vessels[1] and fallopian tubes[2], in the late 1970s. Since then, more investigators have welded a larger variety of tissues[3-13] and have expanded its application to welding trials of ent ertomies of rabbit and rat small intestine[14-17]. Sauer et al[18] reported results from Nd: YAG laser in reconstruction of end-to-end wel ding in rabbit small intestine. Recently, controlled temperature during YAG and argon laser-assisted welding of entertomies of rabbit and rat was implemented to eliminate exponential increases in the rate of denaturation associated with rapidly increasing temperature[19,20]. Yet there was no report of sutureless end-to-end bowel anastomosis using low-power CO2 laser. This is a repor t of a circumferential end-to-end laser welding bowel anastomosis in rabbit by using 3 different CO2 laser powers to explore the feasibility of CO2 laser welding of a circumferential intestinal tissue and to determine the optimal la ser-welding parameter. Then the appropriate CO2 laser power was chosen to weld bowels in rabbit and its long-term healing effect was evaluated.

Detection and recovery of Rhizoctonia solani in naturally infested glasshouse soils using a combined baiting, double monoclonal antibody ELISA

A combined baiting, double monoclonal antibody immunoassay was developed that allows specific and sensitive detection of the economically important soil‐borne plant pathogen Rhizoctonia solani in naturally infested soils. The assay is quick, taking only three days to complete from receipt of soil samples and the immunoassay format allows recovery of Rhizoctonia isolates from colonized baits for determination of anastomosis group (AG) affiliation and pathogenicity. The assay was tested on naturally infested soils from commercial glasshouses used to grow lettuce. Using the immunoassay, conventional anastomosis tests against known AG isolates, and pathogenicity tests, it was shown that R. solani isolates recovered from soil samples were pathogenic towards lettuce and belonged to AG4. Furthermore, those isolates that exhibited strong pathogenicity towards lettuce were recovered from sites that had experienced severe Rhizoctonia damage in previous lettuce crops. The possibility of developing a preplanting test to predict damage to specific crop plants due to the presence of particular AGs in the soil is discussed.

Effects of invaginating anastomosis in Kasai hepatic portoenterostomy on resolution of jaundice, and long-term outcome for patients with biliary atresia

Background/Purpose: This report describes a technique of hepatic portoenterostomy (HPE) to keep sustained bile drainage in biliary atresia patients. In conventional HPE, the medial posterior row of the anastomosis is placed behind the main portal vein. But around both lateral corners where the portal branches enter the liver parenchyma, the anastomosis is placed across and outside of the portal veins. Resultantly, the proximal part of the portal veins become included in anastomosis attaching directly to the dissected area where bile ducts are copious. In a devised procedure designated as invaginating anastomosis (IA), an anastomotic line was placed to invaginate the medial branch of the right portal vein and also placed behind the veins even at their roots. This technique puts all portal branches outside of the anastomosis, preventing cicatricial adhesion at the dissected area with the posterior wall of the veins. Methods: The effect of IA was evaluated in terms of resolution of jaundice and long-term outcome compared with conventional anastomosis (CA). Group IA consisted of 20 patients and group CA of 18 patients. Results: Patients in whom jaundice resolved included 19 (95%) in group IA and 11 (61%) in group CA ( P < .05). Reoperation was needed in only one infant in group IA, and in six in CA ( P < .05). In patients with reoperation in group CA, the portahepatis was found to be contracted with dense cicatricial tissues. The survival rates for patients with a native liver, calculated excluding those in whom the cause of death was not liver deterioration, was 87% for IA compared with 41% for CA ( P < .05). Averaged biliary atresia prognostic index at the last follow-up evaluation was 20.2 ± 24.5 for group IA and 62.6 ± 29.8 for group CA ( P < .001). Conclusion: The invaginating anastomosis in portoenterostomy promised a sustained bile drainage and improved long-term outcome by preventing cicatrical contraction of the portahepatis.

Robotic computer-assisted telemanipulation enhances coronary artery bypass

Objectives: Totally endoscopic coronary artery bypass grafting depends greatly on perfecting the anastomosis. We tested a new computer-assisted telemanipulation robot (Intuitive Surgical Inc, Mountain View, Calif) in performing endoscopic coronary bypass. Methods: On-bench anastomoses of the porcine arterial graft to the left anterior descending coronary artery were performed with both direct visualization and conventional surgical instruments (group I), endoscopic 3-dimensional visualization and current endoscopic surgical instruments (group II), direct visualization and endoscopic instruments (group III), 3-dimensional endoscopic visualization and conventional surgical instruments (group IV), and telemanipulation robotic with 3-dimensional endoscopic visualization (group V). Anastomoses (n = 6 in each group) were assessed for time (minutes), quality (good = 3, fair = 2, poor = 1), technical difficulty (easy-difficult: 1-4), and patency (100% = 1, >50% = 2, <50% = 3). Results: Anastomotic time was significantly longer in groups II and III than in groups IV and V ( P ≤ .02). Patency was comparable in all groups. Conclusion: Telemanipulation technology may enhance the performance of totally endoscopic coronary artery anastomosis. The facility and time of an Intuitive telemanipulation anastomosis is comparable with that of a conventional anastomosis created under direct vision. (J Thorac Cardiovasc Surg 1999;117:310-3)

Endovascular Grafting of a Popliteal Aneurysm Using the Saphenous Vein

Purpose: To report the successful endovascular exclusion of a popliteal aneurysm using a saphenous vein stent-graft. Methods and Results: A 1.9-cm popliteal aneurysm in a 75-year-old man was excluded by an endovascular stent-graft constructed from a segment of a greater saphenous vein to which a Palmaz stent was attached at its proximal end. The operation was performed through an open posterior approach to the distal popliteal artery. The stent-graft was introduced in retrograde fashion and passed up to the superficial femoral artery, where the proximal stent was deployed. Distally, a conventional anastomosis was performed with standard suture technique. Follow-up at 2 months shows continued exclusion of the aneurysm and patency of the bypass. Conclusions: Saphenous stent-grafting is a promising technique in the less invasive treatment of popliteal aneurysms. Further experience and longer follow-up are required before this technique can replace open surgery in clinical practice.

Morphological analysis of microarterial media repair after 830 nm diode laser assisted end-to-end anastomosis: Comparison with conventional manual suture.

A series of 240 diode laser assisted end-to-end microvascular anastomoses (LAMA) and conventional manual anastomoses (CMA) were performed in the left and right common carotid of Wistar rats, respectively. In comparison with the two anastomotic methods, optic and scanning electron microscopic examinations were achieved from Day 0 to Day 210, in order to clarify the mechanism of media repair after diode laser welding, especially the long-term results. In the LAMA group, the cut vessel edges were welded without obvious thermal necrosis after laser treatment. On Day 10, media repair was underlined by circular bulges corresponding to the folds of cut vessel endings brought together. Inflammatory cells were regularly scattered in the adventitia in the vicinity of the anastomotic site, and were gaining ground intensively in the media by Day 20. At this time, the parallel organization of elastic laminae disappeared while the collagen network developed. On Day 120, irregular elastic fibres aggregated in the anastomotic site. On Day 210, reconstituted elastic lamina was present. In the CMA group, on Day 20, fibrotic repair appeared between cut vessel edges, and the injury incorporated by sutures was important. The elastic laminae were not reconstituted by Day 210 in any case. This microscopic study proves that the long-term repair of diode LAMA facilitates media repair and prevents fibrotic scarring of the media.

Single and multivessel port-access coronary artery bypass grafting with cardioplegic arrest: Technique and reproducibility

Objectives: Although minimally invasive coronary artery bypass grafting is now feasible, using this technique to perform anastomoses on the beating or fibrillating heart may yield poorer graft patency than the standard open techniques that use cardioplegic arrest. This study tested the feasibility and anastomotic reproducibility of minimally invasive coronary bypass using newly developed port-access coronary artery bypass technology (Heartport, Inc., Redwood City, Calif.), which allows endovascular cardiopulmonary bypass, cardiac venting, aortic occlusion, and cardioplegic arrest for internal thoracic artery–coronary artery anastomoses. Methods: Nineteen dogs had thoracoscopic takedown of either single ( n = 14) or bilateral ( n = 5) internal thoracic arteries followed by minimally invasive coronary bypass with cardioplegic arrest, done by means of the port-access system. The anastomotic technique was modified after the fourth animal by switching from a microscope to a 2.5 cm oval port and performing a conventional anastomosis with operative loupes. The adequacy of delivery of cardioplegic solution, ventricular decompression, and anastomotic patency was assessed. Results: The crossclamp and bypass times were 50 ± 15 minutes and 87 ± 28 minutes (mean ± standard deviation), respectively. The mean myocardial temperature after cardioplegia was 17° ± 1° C and the aortic pressure (–3 ± 9 mm Hg) and pulmonary artery pressure (4 ± 1 mm Hg) were low throughout the procedure. All animals were weaned from bypass without inotropic agents. Angiograms and autopsies demonstrated successful thoracic artery takedown and anastomotic patency in 18 of 19 animals, with 100% anastomotic patency after the technique had been modified after the fourth animal. Conclusion: This study describes a reproducible technique for minimally invasive coronary bypass that allows myocardial protection, anastomotic precision, and predictable thoracic artery graft patency. Clinical trials are indicated(J Thorac Cardiovasc Surg 1997;114:46-52)

Fibrin Glue and Conventional Sutured Vasal Anastomosis in the Rat

The present study was undertaken to evaluate the use of fibrin glue (Tisseel, Immune U.S., Inc) for vasovasostomy and to compare this technique to conventional sutured vasovasostomy. Thirty immature Sprague-Dawley rats, weighing from 60 to 80 g, were used in this study. A conventional one-layer sutured anastomosis (Ethilon 10-0) in 10 rats was compared to a fibrin glue technique of vasal anastomosis (10 rats). The fibrin glue technique was performed without sutures and was unstented. The biological glue was utilized to seal both ends of the vas. The contralateral vas was ligated with 5-O prolein. In the control group (10 rats) the left vas was ligated in the same way, and only the contralateral vas was explored. After 2 months, one male and two female rats were placed in a cage for a further 2 months. At the end of this period, the fertility rate was 80% (n = 8) of the control group, 60% (n = 6) of the conventional anastomosis, and 70% (n = 7) of fibrin glue groups, respectively. The testes and vasal specimens were evaluated for the presence of sperm granuloma, and histologic studies were performed. The incidence of sperm granuloma after vasovasostomy was 20% (n = 2) for the fibrin glue group and 30% (n = 3) for the sutured group. The sperms were seen in the proximal and distal side of the vasal anastomosis in 10 rats in the control group, in 8 in the glue group, and in 8 in the conventional sutured anastomosis group. Histology of testes revealed similar morphological changes in the area of anastomosis with both techniques. Operative time for sutured vasovasostomy averaged 31 min compared to an average of 10 min for the glue group. This study indicates that fibrin glue is a potentially useful adjunct to vasovasostomy.

Sutureless anastomosis using a biofragmentable anastomosis ring.

The biofragmentable anastomosis ring (BAR) is composed of polyglycolic acid and barium sulfate. When used for intestinal anastomosis, the BAR fragments after the anastomosis is established. We used this device in 43 patients. In three patients, the anastomosis with BAR was abandoned due to technical difficulties. A total of 43 anastomoses with BAR were performed in 40 patients. The operations in which BAR was used included right hemicolectomy in 12 patients, transverse colectomy in 7, sigmoidectomy in 11, small bowel resection in 5 and other bowel resections in 8. The time spent for the BAR anastomsis ranged from 7 to 30 min with a mean of 15.2 min, which was significantly shorter than that of conventional hand-sutured anastomosis in 23 cases. The fragmentation and excretion of the BAR occurred from 14 to 49 days later with a mean of 21.8 days. There was only one instance of anastomotic leakage (1/40, 2.5%), which occurred in a patient with a cytomegaloviral infection of the intestine. A postoperative barium enema study in 28 patients showed no passage disturbance through the anastomosis. In conclusion, the anastomosis using BAR is considered to be a simple, safe, and fast method for performing either colonic or small intestinal anastomosis.

Comparison of laser vascular welding, interrupted sutures, and continuous sutures in growing vascular anastomoses

The argon laser-assisted vascular anastomosis may solve the problems of conventional sutured anastomosis, such as vascular stenosis and arrest of growth owing to a foreign-body reaction to suture material. Twelve argon laser-assisted vascular anastomoses, seven conventional anastomoses with interrupted sutures, and five conventional anastomoses with continuous sutures were performed in 12 young mongrel dogs. Five months later, the external diameter at the anastomosis had increased 70.5% in the laser group, 67.0% in the interrupted suture group, and 22.9% in the continuous suture group. Histological examination of the laser-assisted anastomoses showed almost complete healing, with no granulomatous response around the anastomotic site. In the interrupted suture group, marked scaring and foreign body reactions were observed on the vessel wall at the site of the anastomosis. The continuous suture group showed more remarkable disorientation of the vascular layer and intimal hyperplasia than the interrupted suture group. Vascular anastomosis using the argon laser offers advantages over the conventional procedure in growing vessels.

Late Results of Clinical Experience with Small Caliber Biological Grafts

Small caliber biological grafts that were heparinized and nonheparinized were implanted in 52 patients with arterial obstructive disease and chronic renal failure by either conventional suture anastomosis or laser anastomosis over the last 8 years. There were no operative mortalities. The overall postoperative patency rate was 91% at 1 year, 85% at 3 years, and 82% at 5 years. The heparinized graft anastomosed by laser clearly had the best results with a 100% patency rate at 5 years without pathological anastomotic intimal hyperplasia. Therefore, the heparinized biological graft anastomosed by laser could be the best option for the reconstruction of small vessels although these grafts might be clinically useful for small caliber grafts.

First experimental sutureless end-to-end laser anastomosis of the large bowel. Short-term results.

Completely sutureless end-to-end large bowel anastomoses were successfully created in New Zealand white rabbits (n = 26) by using a low-energy (0.4-W wave of power) Nd:YAG laser to produce welded anastomoses. In this study, the short-term integrity, degree of narrowing, macroscopic appearance, and microscopic findings were compared with those of the conventional interrupted one-layer anastomosis (n = 24) at zero, one, four, and seven days after surgery. Two rabbits in the laser group died from leakage. All remaining animals had an uneventful postoperative course. The bursting pressures in the laser group at zero, one, and four days were lower than those in the control group. The narrowing index of the laser anastomosis was higher than that of the suture anastomosis at four and seven days. However, the laser anastomoses showed fewer adhesions, no instances of bowel obstruction, and histologic healing with less fibrosis. The technique of laser anastomosis presents a promising alternative to suturing in reconstitution of the large bowel.