Telescopic Anastomosis Research Articles

Aortic root remodeling after surgical repair of acute type A aortic dissection using different anastomosis techniques.

After surgical repair of acute type A aortic dissection (aTAAD), remodeling of the residual aortic segments is the key outcome parameter associated with late reoperation or aorta-related adverse events. In this study, we analyzed the surgical outcomes of aTAAD using either a telescopic or continuous anastomosis technique, focusing on their impact on aortic root remodeling during the longitudinal follow-up. Between 2012 and 2018, 112 surgical repairs of aTAAD with ascending aorta replacement and without aortic arch or aortic root replacement were performed. The medical records were reviewed retrospectively, and early and late outcomes were compared between the telescopic and continuous anastomosis techniques. The generalized estimating equation method was used to analyze the effects of different anastomosis techniques on serial aortic root remodeling. The telescopic anastomosis technique was used in 46 cases (41.1%), and the conventional continuous anastomosis technique was used in 66 cases (58.9%). There were no differences in in-hospital mortality or the incidence of major complications between the groups. The telescopic anastomosis group demonstrated stable postoperative regression of the aortic root diameter during follow-up. In contrast, the continuous anastomosis group showed a progressive dilatation of the aortic root. There was a trend toward better aortic root adverse event-free survival rates in the telescopic anastomosis group (P=.081). The telescopic anastomosis technique is a safe alternative to the continuous anastomosis technique in the surgical repair of aTAAD, with comparable early results. In addition, telescopic anastomosis was associated with beneficial aortic root remodeling in the medium term compared with continuous anastomosis.

Risk factors and prognosis of airway complications in lung transplant recipients: A systematic review and meta-analysis

Airway complications (AC) are one of leading causes of morbidity and mortality after lung transplant (LTx), but their predictors and outcomes remain controversial. This study aimed to identify potential risk factors and prognosis of AC . A systematic review was performed by searching PubMed, Embase, and Cochrane Library. All observational studies reporting outcome and potential factors of AC after LTx were included. The incidence, mortality, and estimated effect of each factor for AC were pooled by using the fixed-effects model or random-effects model. Thirty-eight eligible studies with 52,116 patients undergoing LTx were included for meta-analysis. The pooled incidence of AC was 12.4% (95%Cl: 9.5-15.8) and the mean time of occurrence was 95.6 days. AC-related mortality rates at 30-days, 90-days, 6 months, 1 year, and 5 years were 6.7%, 17.9%, 18.2%, 23.6%, and 66.0%, respectively. Airway dehiscence was the most severe type with a high mortality at 30 days (60.9%, 95%Cl: 20.6-95.2). We found that AC was associated with a higher risk of mortality in LTx recipients (hazard ratio [HR] 1.71, 95%Cl 1.04-2.81). Eleven significant predictors for AC were also identified, including male donor, male recipient, diagnosis of COPD, hospitalization, early rejection, postoperative infection, extracorporeal membrane oxygenation, mechanical ventilation, telescopic anastomosis, and bilateral and right-sided LTx. AC was significantly associated with higher mortality after LTx, especially for dehiscence. Targeted prophylaxis for modifiable factors and enhanced early bronchoscopy surveillance after LTx may improve the disease burden of AC.

A purpose of colorectal anastomosis

This review aimed to define and evaluate the new technique which telescopic anastomosis in managing intestinal injuries like leakages. The method gives a fast, secure, and easy approach in limiting intestine leakages. Moreover, the need to determine the credibility of telescopic anastomosis made the research focus on comparing the new technique with the suturing method. The study applied 18 dogs weighing approximately 20-30 kg and divided into two groups (A and B). All the animals were injected with intra-abdominal infection using small perforation in the bowel. Primarily, the animals were left to settle for almost 24 hours before closing the perforation by telescopic anastomosis in group B and simple hand suturing for group A. Notably, the animals were operated after some time, and the anastomosis regions have taken for radiologic analysis. The results showed stenosis in 6 animals of group B because of telescopic anastomosis even without a leakage. Thus, the outcomes provided telescopic anastomosis as an essential method to repair intestine leakages compared to other methods like a suture.

Different results of tracheoplasty for various tracheal diseases

Background: Tracheoplasty is a challenging surgical procedure for treating tracheal diseases. Preserving the voice and achieving normal breaths are considered favorable results. This article reports the mid-term results of tracheoplasty. Materials and Methods: From July 1988 to June 2018, a total of 91 adults with various tracheal diseases who underwent tracheoplasty were enrolled in this study. Tracheal diseases were divided into two categories. Category 1 was not related to neoplasm and included posttracheostomy or postintubation tracheal stenosis, caustic tracheal stricture, tuberculous tracheal stenosis, and congenital tracheal stenosis. Category 2 was related to neoplasm and included tracheal neoplasm and tracheal invasion by thyroid cancer or esophageal cancer. The surgical procedures mainly involved segmental resection of the trachea, telescopic anastomosis following a middle split of thyroid-cricoid cartilage, spiral tracheoplasty, and slide tracheoplasty. Results: One hospital death (1.1%) occurred. Favorable results of tracheoplasty were 81.3% (74/91). The failure rate of tracheoplasty was higher in Category 1 (24.2%, 15/62) than Category 2 (3.6%, 1/28). The subglottic involvement also induced a higher failure rate of tracheoplasty (35.3%, 6/17 vs. 13.7%, 10/73). However, the multivariate logistic regression model demonstrated that the category of tracheal disease and subglottis involvement did not statistically significant induce surgical failure of tracheoplasty. Sixteen (17.6%) patients had surgical failure resulted from anastomotic leaks, regrowth of granulation, or subglottic involvement. Conclusions: Carefully evaluating the tracheal lesions and selecting the appropriate surgical procedure can yield favorable results of tracheoplasty.

Editorial on the article “Pancreatic fistula after pancreaticoduodenectomy. Pancreaticogastrostomy vs. pan- creaticojejunostomy”

Pancreatic fistula is the most dreaded complication after pancreaticoduodenectomy due to its morbidity and mortality. Multiple procedures to reduce the incidence of this complication have been described: a- Systematic inhibition of pancreatic enzyme secretion using octapeptide in the postoperative period; bUse of biological fibrin-based adhesive to cover and reinforce the anastomosis; c- Use of omentum flap to wrap the pancreatic anastomosis with the jejunum; dAnastomosis with Wirsung duct stenting; e- Telescopic anastomosis; f- Duct-to-mucosa anastomosis (the most commonly used technique today); g- Use of magnification, etc

Right side sleeves

Right bronchial sleeve resection is a demanding surgical technique that is applied in case of lung tumors or lymph nodes invading the origin of the right lobar bronchus. Sometimes the tumor invades also the pulmonary artery (PA) and in this instance, a vascular resection and reconstruction of the artery may be required. On the right side, the most frequent bronchoplastic procedure is the upper lobe sleeve resection with the anastomosis of the mainstem bronchus with the bronchus intermedius. Exceptionally, a middle lobe sleeve resection or a sleeve bilobectomy may be required. In every case, the technique of the bronchoplasty includes the anastomosis between the two bronchial stumps with two running sutures with a non-absorbable monofilament obtaining a telescopic anastomosis. In case of PA involvement, an angioplasty may be associated. In this review we report our experience in treating lung cancer infiltrating the origin of the upper bronchus, the middle bronchus and the intermediate bronchus requiring resection and reconstruction describing the surgical anatomy of right bronchial and vascular tree, and illustrating in details our surgical technique of bronchoplasty.

Left side sleeves

Left bronchial sleeve resection is a particular surgical technique sometimes required for treating lung cancer arising at the origin of a lobar bronchus. In some cases, this technique is required for resecting a neoplastic hilar node infiltrating the upper left bronchus. In some instances, these neoplastic lesions may infiltrate also the pulmonary artery requiring a double sleeve resection (bronchial and arterial) and reconstruction in order to preserve as much lung parenchyma as technically and oncologically possible. Bronchial reconstruction (the anastomosis between the main left bronchus and the left lower bronchus) is performed with two running sutures with a non-absorbable monofilament in order to obtain a telescopic anastomosis. PA can be infiltrated by the tumor to various levels, from partial infiltration to a more extensive and even circumferential involvement. In case of partial involvement, a partial resection with suture of the PA is indicated; in case of extended involvement, the reconstruction of the PA may be made by using pericardial patch, end-to-end anastomosis, or by the interposition of a prosthetic conduit. In this review, we report our experience in treating lung cancer infiltrating the left pulmonary artery and the left upper bronchus requiring a double sleeve resection and reconstruction. We also describe the workup of these patients and we illustrate in details our surgical technique.

Collagen-conjugated tracheal prosthesis tested in dogs without omental wrapping and silicone stenting.

Artificial tracheas fabricated from collagen-conjugated mesh appear to overcome fatal postoperative complications, namely anastomotic dehiscence and prosthesis dislocation. Such prostheses are incorporated by host tissue, provided they are wrapped in omentum (necessitating an additional abdominal procedure) and a silicone tube is used as a stent (to be extracted several weeks postoperatively). To mitigate related host impact (i.e. injury, pain and distress), we investigated the feasibility of implanting this type of tracheal prosthesis (∼5 cm in length) alone, without omental wrapping and use of a silicone stent. Porous-type tracheal prostheses that were reinforced with a continuous polypropylene spiral and sealed by collagen sponge from porcine skin replaced segments of cervical trachea (∼5 cm long) in 10 dogs through the method of telescopic anastomosis. Omental wrapping and silicone stent placement were omitted. Postoperatively, bronchoscopic examination was performed periodically. When dogs died or were sacrificed, tracheal prostheses were harvested for haematoxylin and eosin staining and electron microscopic scanning of luminal surface conditions. With the exception of one death from an anaesthesia-related incident during fibre-optic bronchoscopy (postsurgical week 1), nine dogs survived uneventfully (until sacrifice), without prosthesis dislocation or anastomotic dehiscence. The longest observation period was 2 years and 8 months. Bronchoscopic examination revealed that no stenosis or local infection was evident in the prostheses of five dogs. Moderate (n = 2) and slight (n = 2) stenoses were observed in the other four animals. All four animals survived for a long time, without dyspnoea or stridor. Histological examination showed that partial inner surface of the artificial trachea was covered with the pseudostratified ciliated epithelium. Regeneration of ciliated epithelium was also confirmed by scanning electron microscopy. This pilot study revealed that implantation of a collagen-conjugated tracheal prosthesis (∼5 cm in length) is feasible without the need for omental wrapping and silicone stenting as ancillary measures. This approach considerably simplified the surgical procedures to minimize host intrusion, which indicated a possible clinical application.

Clinical efficacy of laparoscopic radical resection for rectal cancer using transanal telescopic anastomosis

Objective To investigate the clinical efficacy of laparoscopic radical resection for rectal cancer using transanal telescopic anastomosis. Methods The clinical data of 52 patients with low rectal cancer who underwent laparoscopic radical resection using transanal telescopic anastomosis at the General Hospital of Beijing Military Command from March 2010 to December 2014 were retrospectively analyzed. Patients with T2N1 stage received the routine chemotherapy after operation. The evaluating indexes of clinical efficacy included operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time, duration of hospital stay, postoperative complications, marginal states, postoperative anal defecation function and local recurrence of tumors. Patients were followed up by outpatient and inpatient examinations and telephone interview up to March 2015, and follow-up included the occurrence of complications, postoperative anal defecation function and local recurrence of tumors. Measurement data with normal distribution were presented as ±s, and measurement data with skew distribution were described as M (range). Results Fifth-two patients underwent transanal laparoscopic sphincter-preserving radical resection using telescopic anastomosis successfully. The operation time, volume of intraoperative blood loss, number of lymph nodes dissection, time to anal exsufflation, pelvic drainage-tube removal time and duration of hospital stay were (150±36)minutes, (16±9)mL, 12±9, (2.0±1.5)days, (5.0±2.0)days and (9.0±2.5)days, respectively. One patient with anastomotic fistula was cured by transverse colostomy, with a stoma healing 3 months later. The postoperative pathological examination showed there were 46 patients with high- and moderate- differentiated adenocarcinomas and 6 patients with poor-differentiated adenocarcinomas, and T1-2N0M0 stage was detected in 29 patients and T2N1-2M0 stage in 23 patients. The distal and circumferential resection margins of tumors were negative. The defecation of 6-9 times/day in 52 patients after postoperative early food intake was reduced to 3-6 times/day after taking orally compound diphenoxylate tablets 2 pills each time and 3 times a day for 2-3 days. Twenty-three patients with T2N1 stage or above underwent postoperative routine chemotherapy. Fifth-two patients were followed up for a median time of 29.7 months (range, 3.0-51.0 months). The defecation control was improved remarkably at 2-3 months after operation. There was 94.2%(49/52) of patients with Kirwan grade 1of anal defecation function at postoperative month 12, and anal defecation function had basically returned to normal. There were 3 patients with Kirwan grade 2 of anal defecation function. One patient complicated with anastomotic stenosis had remission by anal expansion treatment during follow-up. Patients had no local recurrence of tumor with good quality of life. Conclusion Laparoscopic radical resection for low rectal cancer using transanal telescopic anastomosis is safe and feasible without abdominal incision, with a good cosmetic effect and satisfactory short-term outcome. Key words: Rectal neoplasms; Radical resection; Telescopic anastomosis; Laparoscopy

Transanal laparoscopic radical resection with telescopic anastomosis for low rectal cancer

To assess the safety, feasibility and clinical outcome of laparoscopic radical resection for low rectal cancer with telescopic anastomosis or with colostomy by stapler through transanal resection without abdominal incisions. From January 2010 to September 2014, 37 patients underwent laparoscopic radical resection for low rectal cancer through transanal resection without abdominal incisions. The tumors were 4-7 cm above the anal verge. On preoperative assessment, 26 cases were T1N0M0 and 11 were T2N0M0. For all cases, successful surgery was performed. In telescopic anastomosis group, the mean operative time was (178±21) min, with average blood loss of (76±11) ml and (13±7) lymph nodes harvested. Return of bowel function was (3.0±1.2) d and the hospital stay was (12.0±4.2) d without postoperative complications. Patients were followed up for 3-45 months. Twelve months after surgery, 94.6%(35/37) patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. Laparoscopic radical resection for low rectal cancer with telescopic anastomosis or colostomy by stapler through transanal resection without abdominal incisions is safe and feasible. Satisfactory clinical outcome can be achieved mini-invasively.

Laparoscopic resection of lower rectal cancer with telescopic anastomosis without abdominal incisions

To assess laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions. From March 2010 to June 2014, 30 patients (14 men and 16 women, aged 36-78 years, mean age 59.8 years) underwent laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through anus-preserving transanal resection. The tumors were 5-7 cm away from the anal margin in 24 cases, and 4 cm in six cases. In preoperative assessment, there were 21 cases of T1N0M0 and nine of T2N0M0. Through the middle approach, the sigmoid mesentery was freed at the root with an ultrasonic scalpel and the roots of the inferior mesenteric artery and vein were dissected, clamped and cut. Following the total mesorectal excision principle, the rectum was separated until the anorectal ring reached 3-5 cm from the distal end of the tumor. For perineal surgery, a ring incision was made 2 cm above the dentate line, and sharp dissection was performed submucosally towards the superior direction, until the plane of the levator ani muscle, to transect the rectum. The rectum and distal sigmoid colon were removed together from the anus, followed by a telescopic anastomosis between the full thickness of the proximal colon and the mucosa and submucosal tissue of the rectum. For the present cohort of 30 cases, the mean operative time was 178 min, with an average of 13 positive lymph nodes detected. One case of postoperative anastomotic leak was observed, requiring temporary colostomy, which was closed and recovered 3 mo later. The postoperative pathology showed T1-T2N0M0 in 19 cases and T2N1M0 in 11 cases. Twelve months after surgery, 94.4% patients achieved anal function Kirwan grade 1, indicating that their anal function returned to normal. The patients were followed up for 1-36 mo, with an average of 23 mo. There was no local recurrence, and 17 patients survived for > 3 years (with a survival rate of 100%). Laparoscopic radical resection of lower rectal cancer with telescopic anastomosis through transanal resection without abdominal incisions is safe and feasible.

Single-Stitch Telescopic Bilioenterostomy in an Animal Model

ABSTRACTBackground/Aims: An end-to-side biliodigestive anastomosis is the most common procedure performed in hepato-pancreato-biliary surgery, and this procedure may become technically demanding. A telescopic ureterovesical anastomosis is frequently used in transplant surgery. The aim of this study was to investigate the feasibility of constructing a telescopic biliodigestive anastomosis. Methodology: The technique-standardization (n = 8) and main study (n = 3) groups were formed from 11 pigs. A single-stitch telescopic anastomosis with a self-disposable internal stent was performed in the main study group. The animals were sacrificed at the end of the 4-week follow-up period, and cholangiograms and tissue samples were obtained. Repeated biological, hematological, and biochemical data were recorded. Results: No bilomas or functional biliary strictures were identified in any of the main study group animals. Light microscopy revealed intestinal metaplasia of the biliary epithelium in the portion of the bile duct telescoped inside the intestinal lumen. Conclusions: Telescopic bilioenterostomy with a single pull-through stitch and a self-disposable stent is quick and reproducible in animal models, and it appears to be free of complications. Further experiments with longer follow-up periods are required to confirm that this anastomotic technique does not lead to episodes of delayed cholangitis or development of adenocarcinoma.

Telescoping Colonic Anastomosis in Dogs: Gross and Microscopic Configurations

Introduction: Colorectal anastomotic leakage remains one of the most feared post-operative complications. The telescoping technique has been used but never widely acclaimed. The aim was to study both the external and internal features as well as the microscopic configuration of the invaginating colocolic anastomosis. Materials and Methods: After the scheduled three-week post-operative period, animals were reopened for a second-look laparotomy to detect: an external appearance of the anastomosis, internal appearance of the anastomosis and histopathological study. Results: Good and fair ratings were seen for external and internal appearance of the anastomosis, while no poor ratings were detected in our experiments. Microscopic study revealed a good healing process of the anastomotic lines. Conclusion: Our data showed that the telescopic anastomosis is a secure, easy to be constructed, fast and cheap procedure for colonic anastomoses.

Telescopic straight ileo-anal anastomosis in dogs

To study outcomes and functional results of a telescopic straight ileo-anal anastomosis. Thirty-six mongrel dogs were submitted to total proctocolectomy and telescopic straight ileo-anal anastomosis (ileal mucosa-submucosa pulled-through the rectal cuff). They were divided in 3 groups, sacrificed after one, two or eight weeks after the initial procedure. Gross and microscopic (degree of cooptation and signs of ischemia) aspects of the anastomosis, as well, the aspect of defecation were analyzed. On microscopy all anastomosis analysed showed a continuous epithelial line and were considered good. After two-months no signs of ischemia were identified. Defecation aspect has considerably changed during the study, so no dogs presented solid defecation within the first two weeks, whereas 80% of dogs presented solid stools after two months. Telescopic ileo-anal anastomosis is a safe alternative and may provide good functional results after some small period of time.

Analysis of 61 cases undergoing sphincter-preserving procedure with intersphincteric resection by telescopic anastomosis for ultra-low rectal cancer

To investigate the efficacy and safety of sphincter-preserving procedure with transabdominal intersphincteric resection for ultra-low rectal cancer. Clinical data of 61 cases with ultra-low rectal cancer (distance from anal verge ranged from 4-5 cm) were analyzed retrospectively. The patients underwent sphincter-preserving procedure with intersphincteric resection and telescopic anastomosis. There were 34 males and 27 females. The mean age was 56.7 years. The inferior border of the tumor was 4 cm above the anal verge in 21 cases, and 5 cm in 40 cases. There 55 patients with rectal adenocarcinoma in this cohort. The tumor was well-differentiated in 24 cases, moderately-differentiated in 29 cases, and poorly-differentiated in 2 cases. There were 6 cases with malignant adenoma. The TNM staging was T1N0M0 in 36 cases, T2N0M0 in 23, and T3N1M0 in 2. The ability to control defecation significantly improved in 1-3 months postoperatively, and returned to normal in 6-12 months. Two patients developed anastomotic leak (3.3%), and 3 anastomotic stenosis (4.9%) postoperatively. Fifty-four patients(88.5%) had follow-up. The median follow-up time was 6.2 years. The local recurrence rate was 5.6%, and the 5-year-survival rate was 73.5%. Sphincter-preserving procedure with intersphincteric resection and telescopic anastomosis is a safe and effective procedure for ultra-low rectal cancer.

Clinical study of laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis

To investigate the safety, feasibility and clinical outcomes of laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis. Five patients underwent laparoscopic sphincter-preserving proctectomy for low rectal cancer using transanal telescopic anastomosis between March 2011 and April 2011 at the General Hospital of Beijing Military Command. After lymph node dissection around the mesentery using harmonic scalpel, the root of the inferior mesenteric vessel was ligated and transected. Rectal dissection was further carried out until 5 cm distal to the lower margin of the tumor. A circumferential incision was made 1.0 cm above the dentate line using 5 support stitches for exposure. The submucous layer was striped upward to the level of the levator ani, and rectum was transected. Rectum and sigmoid colon were extracted transanally and removed. Finally, colonanal anastomosis was made using telescopic technique. Five patients underwent the procedure successfully. The mean operative time was 178 minutes. The mean intraoperative blood loss was 76 ml. The mean lymph nodes retrieval was 14. Bowel function recovered after a mean of 3 days. There were no postoperative complications. No obvious scars were seen in the abdomen or the anus. The mean hospital stay was 12 days. After one year of follow-up, all the patients survived cancer-free. Laparoscopic anterior resection with sphincter preservation by transanal telescopic anastomosis for low rectal cancer is feasible and safe. Abdominal incision is minimal. However, the long-term outcomes require further investigation.

Double Telescopic Anastomosis With Interrupted Suture Technique in Acute Aortic Dissection

We describe a new method for aortic anastomosis in the repair of acute aortic dissection. The anastomosis sites are prepared and sutured in an interrupted horizontal mattress manner with telescoping technique. By this kind of method, the interrupted sutures decrease damage to the fragile aortic wall and the antegrade blood flow promotes anastomotic sealing. This interrupted telescoping suturing technique will greatly help in managing aortic dissecting disease.

Clinical experience of 371 cases of sphincter-preservation with telescopic anastomosis after radical excision for low-middle rectal cancer

To evaluate the clinical efficacy, feasibility and safety of sphincter-preservation with telescopic anastomosis of colon and rectal mucosa in low-middle rectal cancer. A retrospective analysis was carried out in 371 patients with low-middle rectal cancer in whom telescopic anastomosis was used. There were 224 males and 147 females, with a mean age of 57.9 (21-99) years. The lower margins of the tumors located between 5-8 cm from the anal verge. On histopathology, there were 361 adenocarcinomas, including 138 well-differentiated, 201 moderately differentiated, 11 poorly differentiated, 11 mucinous adenocarcinoma, and 10 adenomas with neoplastic changes. According to the Duke's stage classification, 120 were TNM stage I, 222 stage II, 26 stage III, and 3 stage IV. Three hundred and eighteen (318/371, 85.7%) cases were followed up, and the median follow up time was 5.8 years. Postoperative complications were observed, including 16(4.3%) cases with anastomotic leak, and 8 (2.1%) with anastomotic stenosis. All the patients resumed normal bowel function during 12-24 weeks after operation, with 1-3 times per day. The local recurrence rate was 6.3% (20/318). Hepatic and lung metastasis was 14.5% (46/318) and 2.5% (8/318), respectively. The 5-year survival rate was 69.7%. The sphincter-preservation with telescopic anastomosis procedure is safe and effective for low-middle rectal cancer, and the sphincter function can be well-preserved.

Carinoplasty with Telescope Anastomosis for Tuberculous Bronchial Stenosis

A 25-year-old women developed severe stenosis of the right main bronchus after medical treatment for pulmonary tuberculosis in the right upper lobe. She underwent a right upper sleeve lobectomy with partial excision of the right main bronchus and right side of the carina. Reconstruction was performed using telescopic anastomosis between the carina and intermediate bronchus. Her symptoms improved immediately.

Modified Sleeve Anastomosis in Large Muscular Arteries of Sheep

ObjectiveThe purpose of this investigation was to test a modified telescopic anastomosis in large muscular arteries. Material and methodsThe right carotid arteries in 30 sheep (average weight 57±5.7kg) were transected and anastomosed end to end using two guided sutures and compared with a control group (10 sheeps) using two external sutures (Lauritzen method). ResultsThe mean time to complete the anastomosis (4.5min) and hemostasis (4.3min) in the experimental group was less than the control group (17.3min for anastomosis and 6.4min for hemostasis) (P<0.05). In addition, the total amount of blood loss during the modified anastomosis was significantly lower than Lauritzen method (3.8 versus 8ml). In both experimental and control groups the scanning electron microscopy (SEM) at 90th day post-operation revealed a continuous smooth layer of endothelial cells covering the anastomotic junction. ConclusionsAnastomosis with two guided sutures is easy and faster to perform and could be applicable to an acutely transected vessel.