Sutureless Anastomosis Research Articles

Compression anastomoses in colorectal surgery: a review

The main serious risks of anastomotic construction in the colon and rectum include dehiscence and stricture formation. There is a resurgence of interest in sutureless anastomoses formed by compression elements since the introduction of shape memory alloy (SMA) systems, which evoke minimal early inflammatory response whilst maintaining anastomotic integrity. Currently, the most commonly used SMA is the nickel-titanium (NiTi) alloy that is highly biocompatible, returning to its pre-deformed stable (austenite) shape under different mechanical and thermal loads for use in humans. Pre-clinical data for shape memory alloy systems in colorectal anastomoses are limited, but it appears to be safe in porcine and canine models with limited leakage and reduced stricture formation. There does not appear to be any difference in tissue biochemistry of inflammatory markers when compared with conventional stapled techniques, although the few studies available show a markedly reduced early inflammatory response at the anastomotic site with the NiTi device. The majority of the clinical data concerning compression anastomoses are derived from the biofragmentable anastomotic ring device. This device has fallen out of use because of reported leaks, instrumental failure and problems with device expulsion. A novel SMA device, the NiTi anastomotic ring, permits construction of a low rectal anastomosis construction during open or laparoscopic procedures. The preliminary data demonstrate a safety comparable to conventional staple technology. This device also provides the potential of benefit of reduced anastomotic inflammation, because the compression ring results in direct serosa-to-serosa (or alternatively serosa-to-muscularis propria) apposition without the persistence of residual foreign material. This type of construction could lead to a reduced incidence of early anastomotic leakage and/or the development of anastomotic stenosis. Randomized clinical trials employing a NiTi arm for elective, emergency and high-risk colorectal anastomoses are required to determine its indications and clinical profile as well as to assess whether such technology may selectively obviate the need for proximal diversion in low colorectal anastomoses.

A Modular Branched Stent-Graft System for Sutureless Anastomoses in Extensive Aortic Arch Replacement—A Porcine Study

We developed a modular branched stent-graft system to test whether it is feasible for sutureless anastomoses in extensive aortic arch replacement. Extensive aortic arch replacement was performed using the three-branched stent-graft system in eight pigs. Under deep hypothermic circulatory arrest, sutureless anastomoses were established at the distal aortic arch and the two supra-aortic arteries with the modular branched stent-graft system. External bandings on the distal arches were applied in six pigs (banding group) and not applied in two pigs (control group). No external banding was applied on the two supra-aortic arteries. Successful procedures were achieved in all pigs in the banding group, whereas failures were seen in the control group owing to leakage from the distal arch anastomoses. The anastomosis at each distal aortic arch was completed in 10 minutes in the banding group and in 5 minutes in the control group; the anastomosis of each supra-aortic artery was achieved in 5 minutes. Median durations of the circulatory arrest, aortic cross-clamping, and cardiopulmonary bypass were 30, 67, and 174 minutes, respectively. The postoperative computed tomography revealed adequate alignment of the stents and appropriate size matching between stent-graft and native aorta. Histological examinations revealed no pressure necrosis at the sutureless anastomotic sites. This study confirmed the technical feasibility of sutureless anastomoses with the modular branched stent-graft system in porcine extensive aortic arch replacement. An external banding is essential for the secure hemostasis of the distal arch anastomosis, but it is not required for the supra-aortic arteries.

Sutureless jejuno-jejunal anastomosis in gastric cancer patients: a comparison with handsewn procedure in a single institute

BackgroundThe biofragmentable anastomotic ring has been used to this day for various types of anastomosis in the gastrointestinal tract, but it has not yet achieved widespread acceptance among surgeons. The purpose of this retrospective study is to compare surgical outcomes of sutureless with suture method of Roux-and-Y jejunojejunostomy in patients with gastric cancer.MethodsTwo groups of patients were obtained based on anastomosis technique (sutureless group versus hand sewn group): perioperative outcomes were recorded for every patient.ResultsThe mean time spent to complete a sutureless anastomosis was 11±4 min, whereas the time spent to perform hand sewn anastomosis was 23±7 min. Estimated intraoperative blood loss was 178±32ml in the sutureless group and 182±23ml in the suture-method group with no significant differences. No complications were registered related to enteroanastomosis. Intraoperative mortality was none for both groups.ConclusionsThe Biofragmentable Anastomotic Ring offers a safe and time-saving method for the jejuno-jejunal anastomosis in gastric cancer surgery, and for this purpose the ring has been approved as a standard method in our clinic. Nevertheless currently there are few studies on upper gastrointestinal sutureless anastomoses and this could be the reason for the low uptake of this device.

Midterm results of vascular ring connector in open surgery for aortic dissection

This study observed midterm results of vascular ring connectors in surgery for aortic dissection. Vascular ring connectors were used as stents in vascular grafts to achieve quick, sutureless anastomoses. Tapes were used to secure ringed vascular grafts from outside the aorta. From November 2007 to February 2011, 113 consecutive patients with aortic dissection, except 3 in preoperative profound shock, underwent open surgery. All underwent aortic reconstruction with vascular grafts and vascular ring connectors: ascending aorta in 29, descending thoracic aorta in 20, distal hemiarch plus descending thoracic aorta in 22, total arch in 14, ascending aorta plus total arch in 12, total arch plus descending thoracic aorta in 7, ascending aorta plus arch plus descending thoracic aorta in 8, and thoracoabdominal aorta in 1. Concomitant operations were 19 Bentall procedures, 14 coronary bypasses, 2 mitral valve replacements, 1 aortic valve replacement, and 1 heart transplant. We used sternotomy to repair 77% of type B dissections, 83% with elephant trunks. Time to extubation was 9.0 ± 6.2 hours. Average blood loss was 345 ± 195 mL. Half the patients needed no blood transfusion. In-hospital mortality was 5.3%; late mortality was 2.7%. Use of vascular ring connectors in surgical repair for aortic dissection might reduce risks and improve early and midterm results. With addition of elephant trunk, most type B dissections could be repaired through sternotomy. With the improved surgical results, we can suggest open repair for most uncomplicated type B dissections; however, more long-term follow-up is needed.

Magnetic compression anastomosis: a promising technique in the further development of minimal invasive surgery

Magnetic compression anastomosis (MCA)involves the use of two rare-earth magnets that attract to each other transmurally between two internal organs, resulting in compression and subsequent fistula formation to create a nonsurgical enteric, vascular, or biliary anastomosis with therapeutic aims. The magnetic vascular coupler allows a sutureless anastomoses between arteries and veins by using interventional radiological techniques. The MCA technique significantly reduces ischemic time during anastomosis, and has the advantages of low invasiveness and simplicity. It is a rather effective method for recanalizing between various hollow viscera, creating anastomosis such as gastrojejunostomy, choledochojejunostomy, or choledochoduodenostomy.Furthermore, this novel technique is considered to be a feasible and alternative reconstructive method for patients who develop significant bile duct complications following hepaticojejunostomy and living donor liver transplantation. MCA is a promising and novel technique in the further development of minimal invasive surgery. Key words: Magnetic compression anastomosis ; Minimal invasive surgery

Sutureless anastomoses: the main goal for a calcified aorta?

We read with great interest the article written by Dohmen et al. published in the EJCTS January 2011 [1]. The authors reported on their experience with the PAS-Port automated proximal aortic connector device (ACD) in 17 patients with heavily calcified aorta during coronary bypass surgery grafting (CABG). The early graft patency in every patient was proven by computed tomography (CT) scan after 30 days. To avoid aortic manipulation, every CABG procedure was performed in off-pump beating-heart technique, though two patients had to convert to cardiopulmonary bypass (CPB) in case of ventricular fibrillation and hemodynamic instability. These two patients suffered from prolonged reversible neurological deficits (PRIND) and another one from longlasting postoperative delirium. With respect to the older patient population, every heart surgeon is familiar with the problem of severe calcified aorta not only during CABG procedure. As described in the article, there are many different strategies in the literature to cope with this problem during CABG surgery, such as off-pump aortic ‘non-touch technique’ using tor y-arterial grafts to the internal thoracic arteries [2]. The use of ACDs in this special patient population, as stated in the article, is not new. Though many technical problems, for example, proper alignment of the vein graft and early graft thrombosis, were seen in the initial phase after using ACDs, the results are not worse than hand-sutured anastomoses. However, midterm results remain poor and led to abandonment of ACDs in the routine use. Long-term follow-up for ACD patients is hardly

Efficacy of NiTi Hand CAC™ 30 for jejunojejunostomy in gastric cancer surgery: results from a multicenter prospective randomized trial

Although a novel technique for the performance of intestinal sutureless anastomosis using a compression device has recently been investigated, it has not yet received widespread acceptance. We performed a multicenter prospective randomized trial in order to determine the clinical efficacy of the NiTi Hand CAC 30, a type of compression anastomosis clip (CAC), for jejunojejunostomy in gastric cancer surgery. Forty-seven patients from 6 institutions, who were diagnosed with gastric adenocarcinoma, were enrolled; these patients were randomized to a CAC group and a hand-sewn (control) group. Three patients dropped out for various reasons, and results for 44 patients were finally analyzed. The CAC group consisted of 20 patients, and there were 24 patients in the control group. Anastomosis time, the primary endpoint of this trial, was shorter in the CAC group than in the control group (P < 0.001). However, total operation times (P = 0.055) did not differ. All reconstructions were completed by Roux-en-Y anastomosis, and the complication rates of the two groups did not differ (P = 0.908); however, jejunojejunostomy leakage occurred in two patients in the CAC group. Our prospective multicenter clinical trial showed that the use of the NiTi Hand CAC™ 30 for jejunojejunostomy in gastric cancer surgery was feasible and could reduce anastomosis time. However, considering that there were two cases of leakage, extended use of the NiTi Hand CAC™ 30 should be carefully applied.

Novel Suture-Less Vascular Anastomotic Device (BYFix) in Femoro-Popliteal Surgery, Early Clinical Experience

Objectives: To evaluate the early experience of using the BYFix-innovative anastomotic device for creating suture-less vascular anastomosis in major and peripheral arteries surgery. Design: Uncontrolled prospective study. Materials: The BYFix anastomotic device for suture-less vascular anastomosis with surgical tools and standard vascular grafts. Methods: 7 patients, age 63.6 ± 9.2 years, with peripheral vascular occlusion above the knee scheduled for surgical repair were operared. They underwent the surgical procedure using the BYFix anastomotic device for creating proximal anastomosis and the conventional manual suturing for creating the distal anastomosis of the implantable vascular graft. Results: The anastomoses by using BYFix anastomotic device were successfully created in all patients. The duration of anastomosis creation was significantly shorter by using BYFix device, compared to conventional manual suturing, 5:10 ± 1:50 minutes compared to 33 ± 17:40 minutes respectively. No adverse events related to BYFix anastomotic device were observed, during the surgical procedure or recovery period. One year follow up revealed no complications related to BYFix anastomotic device. Conclusions: The BYFix anastomotic device enables the creation of efficient vascular anastomosis in peripheral vascular occlusions. It shortens the time needed for creating vascular anastomosis and thus reducing the operation time and might reduce distal complications related to the vascular procedure. Further clinical trials are needed to establish the results.

Bioabsorbable device for small‐caliber vessel anastomosis

Although the devices for large-caliber vessel (>2-mm diameter) anastomosis are available, there are no devices for performing anastomosis of small-caliber vessels. We designed a hooked device composed of a bioabsorbable polymer for sutureless anastomosis of small-caliber vessels. The efficacy of this device was evaluated by in vitro degradation and arterial-fixation strength tests as well as in vivo transplantation experiments with common carotid arteries of growing SD rats. A nonabsorbable device without hooks served as the control in the fixation strength and animal experiments. The tensile strength of the bioabsorbable device decreased to 27 and 9% of the initial value after 8- and 24-week incubation, respectively. The fixation strength was greater and the anastomotic time was shorter with this device than with the control. The transplantation experiments showed complete endothelial bridging in both devices at 2 weeks after surgery (n = 6). The control device created a considerable protrusion into the arterial lumen at 8 postoperative weeks, whereas the experimental device did not (n = 6). Arterial diameter measurements detected a significant difference between the inner diameters at the respective anastomotic sites (n = 6, P < 0.05) and demonstrated that the control device hindered the vessel growth while the experimental device did not. Therefore, the bioabsorbable hooked device was an effective tool for anastomosis of small-caliber arteries (ca. 1-mm diameter).

Complete Ileal Neobladder Intracorporeal Construction With Standard Sutured Technique and Novel Technology

We compared the surgical efficacy and efficiency of a completely suture based procedure with a novel entero-urethral anastomosis device and an EndoGIA stapler to create an ileal neobladder. Two groups of 7 pigs each were survived for 8 weeks. In group 1 the neobladder was constructed using a U-shaped segment of ileum sealed with the stapler. The entero-urethral anastomosis was created with a novel sutureless anastomosis device. All other procedures were completed with standard intracorporeal suturing techniques. In group 2 animals completely intracorporeal sutured technique was used. Total procedure, and enteroenteric, ileal neobladder, uretero-enteric and entero-urethral anastomosis times were recorded. Cystograms done immediately postoperatively, at 2 weeks and at sacrifice to evaluate the newly constructed system were rated from 0-no leakage to 3-severe leakage. In group 1 vs 2 the overall procedure, and enteroenteric, ileal neobladder, uretero-enteric and entero-urethral anastomoses were completed in 285.3, 32.3, 58.8, 54.2 and 5.5 vs 350.1, 29.9, 139.1, 58.0 and 46.3 minutes, respectively. In groups 1 and 2 the average postoperative cystogram rating was 0.83 and 1.6, respectively (p = 0.63). At 2 weeks and at sacrifice cystograms showed no extravasation in either group. The overall surgical procedure, pouch creation and entero-urethral anastomosis were statistically briefer in group 1 (p = 0.036, 0.01 and 0.039, respectively). Average survival in groups 1 and 2 was 30 (range 4 to 56) and 41 days (range 1 to 56), respectively (p = 0.36). All animals had voiding complications within 1 week after ureteral and urethral catheters were removed. One neobladder ruptured in group 1. Combining stapled ileal neobladder construction and the entero-urethral anastomosis device significantly decreases operative time, pouch creation and urethral anastomoses.

Hemodynamic Performance of a Sutureless Anastomosis Device (the Graft Connector): A Numerical Study

Sutureless anastomosis devices have been developed to facilitate arterial bypass surgery on the beating heart. However, these devices can significantly alter the hemodynamics at the end-to-side anastomosis and in the host artery, leading to the formation of thrombus or/and intimal hyperplasia (IH). In this study, a numerical analysis was performed on the hemodynamic performance of the Graft Connector (GC), a sutureless anastomosis device, under pulsatile flow conditions. The results showed that blood flow was severely disturbed in the GC model with the formation of vortices and flow stagnation at the bed and the toe, and distal to each of the stent struts, which led to low wall shear stresses and high oscillating shear indices in these regions. This may cause severe IH in the host artery and compromise the performance of the device. Based on the numerical study, suggestions were proposed for the design of the GC to improve its performance.

A Novel Technique of Sutureless Colorectal Anastomosis by Bipolar Coagulation

Aim of the study was to test the safety and efficacy of sutureless colorectal anastomosis using bipolar coagulation. Thirty-six Wistar albino rats were used. The rectum just proximal to the peritoneal reflection was transected in 22 rats (Group 1), and the bowel ends were anastomosed or welded end-to-end using bipolar coagulating forceps (Scoville-Greenwood, 60-1765-001, ConMed, USA). Coagulation using 60 milliamperes took one second for each weld. In 14 rats (Group 2), bowel anastomosis was carried out by hand-sewn sutures. The animals were followed up for general condition and body weight, and were sacrificed at six weeks. The anastomoses were studied with regard to burst pressure, stenosis and histopathology. All rats survived, and body weight gain was significant (p<0.01 for Group 1, p<0.05 for Group 2). There were no intraabdominal complications (leakage, obstruction, etc.), except in one rat (in Group 2), who had intraabdominal abscess. Although intraluminal pressure was increased to 40 cm H2O with extensive stretching of the colorectal segment, the anastomoses did not burst or open in either the sutureless or sutured groups. The bowel diameter 1 cm distal and 1 cm proximal to the anastomoses did not show any difference between both groups. Neomucosa completely covered 78% of sutured anastomoses and 36% of sutureless anastomoses (p<0.05). Inflammation developed in 78% of sutured anastomoses and 36% of sutureless anastomoses (p<0.05). Edema, giant cell and mast cell infiltration were equivalent in both anastomoses. Lymphoid tissue hyperplasia markedly appeared in the sutureless anastomoses (p<0.01). This simple technique of sutureless colorectal anastomosis may be useful and offer an alternative to other colorectal anastomosis techniques.

Modified “Sutureless” Anastomosis for Primary Repair of Supracardiac Total Anomalous Pulmonary Venous Connection

Repair of total anomalous pulmonary venous connection (TAPVC) is associated with a risk of recurrent pulmonary venous obstruction. In this article we describe a technique of primary repair using a posterior approach in which a modified sutureless anastomosis is constructed by suturing the left atrium to the posterior pericardium that surrounds the pulmonary venous confluence. This technique avoids trauma to the pulmonary venous wall and minimizes the risk of distortion of the anastomosis, factors that have been implicated in the occurrence of subsequent pulmonary venous obstruction.

A new vascular ring connector in surgery for aortic dissection

To improve the surgical results of aortic dissection, we used a novel vascular ring connector for anastomosis. The vascular ring connector is a titanic ring used as a stent in the vascular graft to achieve a quick, blood-sealed, and sutureless anastomosis. From November 2007 to December 2008, 19 consecutive patients (age range 36-77 years; 16 male and 3 female) with aortic dissection underwent open surgery. All patients received aortic reconstruction with vascular grafts (including 5 cases of arch replacement). The combined procedures were 5 Bentall and 4 coronary artery bypass graft operations. There were no significant blood leaks from the anastomotic sites. The time required for each anastomosis was 1 to 2 minutes. All patients were discharged uneventfully and are still doing well after a follow-up period of 1 to 12 months. The vascular ring connector may improve the early surgical results of aortic dissection by reducing both the time for anastomosis and the risk of bleeding and may be an alternative technique for aortic reconstruction. Its usefulness in the routine treatment of aortic dissection warrants further evaluation.

Evaluation of a Poly(l-lactic acid) Stent for Sutureless Vascular Anastomosis

We have developed a sutureless anastomosis device consisting of a biodegradable stent and stainless steel band for end-to-end anastomosis. The aim of this acute phase study was to evaluate the feasibility of a sutureless anastomotic procedure with a bioabsorbable stent during a 4-week period in a swine model. The porcine infrarenal aorta was replaced with an expanded polytetrafluoroethylene graft. A proximal anastomosis was completed using a sutureless anastomotic procedure employing a bioabsorbable stent made of poly(L-lactic acid) (PLLA) and a stainless steel plate. A distal anastomosis completed by manual suturing served as a control. At 4 weeks after surgery, angiography was performed. The animals were then killed, and the specimens were evaluated histologically. The sutureless anastomotic procedure required significantly less time than the suturing technique. Angiograms showed patency of the grafts, and no signs of either stenosis or leakage. Both pressure-proof and tensile tests confirmed the adequate mechanical strength of the anastomoses. Sutureless anastomosis with a PLLA stent appears to be feasible, at least within an observation period of 4 weeks. This simple procedure shortened the time of surgery and would contribute to reducing the risks of operation-related complications.

Primary Repair of Infracardiac Total Anomalous Pulmonary Venous Connection Using a Modified Sutureless Technique

Primary repair of infracardiac total anomalous pulmonary venous connection is associated with a significant risk of recurrent pulmonary venous obstruction. Herein we describe a technique of primary repair in which a modified sutureless anastomosis is constructed by suturing the left atrium to the posterior mediastinal pleura that surrounds the pulmonary venous confluence.

Sutureless Nerve Repair with Laser-Activated Chitosan Adhesive: A Pilot in Vivo Study

The anastomosis of peripheral nerves is a demanding procedure that has potential complications due to foreign body reactions elicited by sutures. In this study, the sutureless in vivo anastomosis of rat tibial nerves was successfully performed, using for the first time a chitosan-based laser-activated adhesive. The nerve thermal damage caused by the laser irradiation was quantitatively assessed. A novel adhesive composed of chitosan, indocyanine green, acetic acid, and water, was fabricated in thin sheets. Its adhesive strength was tested in vitro by bonding strips (surface area approximately 20 mm2, thickness approximately 20 microm) onto rat sciatic nerves and sheep intestine by laser activation with low fluence ( approximately 50 J/cm2), using a fiber-coupled diode laser (n = 13). The tensile strength of the adhesive/tissue bonds was measured after tissue repair. The chitosan adhesive was then used to perform sutureless anastomosis of tibial nerves in vivo (n = 6). Adhesive strips were also bonded in vivo onto intact rat sciatic nerves (n = 6) in order to quantitatively assess, by counting myelinated axons, the thermal damage induced by the laser. The adhesive bonded well to tissue with a tensile strength of 12.5 +/- 2.6 KPa (mean +/- SD; n = 13). The in vivo anastomosed nerves were in continuity 3 d after surgery. Axon counting showed the number and morphology of myelinated axons were normal proximally ( approximately 96%) compared with intact nerves (100%). Axon demyelination was observed at the operation site ( approximately 49%) and distally ( approximately 27%), and was attributed to laser-induced thermal damage. Nerve anastomosis, performed by the laser-adhesive procedure, was successful 3 d postoperatively. Proximal myelinated axons were not significantly damaged by the low laser fluence.

Sutureless anastomoses of rabbit carotid arteries with BioGlue

Sutureless anastomoses for coronary artery surgery are being investigated for a minimally invasive setup because they are easy to perform and less time-consuming than are sutured anastomoses. The short-term effects of the biocompatible adhesive BioGlue on vascular tissue have been described as potentially unfavorable. The present study investigates the medium-term macroscopic and histologic effects associated with the use of BioGlue on rabbit carotid arteries. Thirty-four carotid arteries of 17 New Zealand White rabbits were available. Nine carotid arteries were left unmanipulated and free of glue, 9 carotid arteries had BioGlue applied as a control, and 16 carotid arteries were transected and reanastomosed with the aid of BioGlue and an endovascular balloon. Of the 16 transected arteries, 4 had to be excluded from further evaluation. Angiographic scanning was performed 60 days postsurgery, after which the animals were euthanized and tissue samples were obtained for macroscopic and histologic examination. The application of BioGlue resulted in a marked invasion of inflammatory cells. The glue partially degraded and was replaced with connective tissue. Obvious calcification of the arterial wall and the capsule that had formed around the glue was present. Stenoses, thrombi, and pseudoaneurysms were predominantly noted in the glued anastomosis group. The results of this study raise concerns about the safety of BioGlue in coronary artery surgery. In light of our results, the use of BioGlue in large-vessel vascular surgery should be considered with great care for each individual patient.

Vein graft anastomoses with magnets

Performing vascular anastomoses requires complete circumferential access and is time-consuming and technically challenging. The purpose of our study was to assess a sutureless magnetic device for anastomosing vein grafts. Oval magnets with a lumen were placed in six male foxhounds. The femoral artery was ligated and an 8 cm length of femoral vein was harvested and reversed. After a 4 mm venotomy or arteriotomy, one magnet was inserted into each vessel lumen and a second magnet was placed outside the vessel but aligned directly over the intraluminal magnet, forming a magnetic port in each vessel. The graft and target vessels were then allowed to self-align and seal, creating a side-to-side anastomosis. Patency was confirmed with duplex Doppler ultrasound scans after 6 and 13 weeks and during explantation after 14 weeks. At that time, the contralateral femoral vein was harvested and an acute graft was created as a control. Macroscopically there was no sign of stenoses or aneurysms. After explant, saline was perfused through all grafts and the hydrodynamic resistance was quantified. There was no significant difference in resistance between the acute and 14-week grafts indicating stenosis. Microscopic examination of 14-week anastomoses showed that all blood-contacting surfaces were well-endothelialised. The magnetic vascular coupler allowed sutureless anastomoses between blood arteries and veins. This device might prove useful for anastomosis of large and small vessels, as well as for anastomosis or approximation of non-vascular structures such as peripheral nerves, fallopian tubes or ureters.

Sutureless Vascular Anastomoses by N-Butyl-2 Cyanoacrylate Adhesive: An Experimental Animal Study

Background: The purpose of this animal study was to find out whether sutureless anastomoses using N-butyl-2-cyanoacrylate were effective in the suppression of neointimal hyperplasia or not. Material and Methods: Ten male adult mongrel dogs were used in this animal study. The animals were randomly divided into a control group (n = 5) and a study group (n = 5). The study group underwent sutureless anastomoses using N-buthyl-2-cyanoacrylate adhesive. Infrarenal aortoaortic graft was interposed using polytetrafluoroethylene. Results: In the study group, the mean intimal thickness at the proximal anastomosis was 27.4 ± 1.94 µm and 27.4 ± 1.51 µm at the distal anastomosis. In the control group, the mean intimal thickness was 138.4 ± 5.02 µm at the proximal anastomosis and 67.6 ± 6.42 µm at the distal anastomosis. Intimal thickness at the proximal and distal anastomoses in the control group was significantly (p < 0.001) greater than in the study group. Also, perianastomotic inflammation was more obvious in the control group compared to the study group (p < 0.01). Conclusion: Sutureless anastomoses using with N-butyl-2-cyanoacrylate adhesive might be a good alternative to conventional suture technique.