Purse-string suture for stapled oesophagogastric anastomosis: hand-sewn versus automatic. 1993

D S O'Riordain, and D J Buckley, and D J Waldron, and W O Kirwan
University Department of Surgery, Regional Hospital, Wilton, Cork, Ireland.

An automatic purse-string device was compared with the traditional hand-sewn method in stapled oesophageal anastomosis. Fifteen greyhound dogs underwent distal oesophagectomy with stapled gastro-oesophageal anastomosis; a purse-string suture was used to draw the distal oesophagus around the stapling device. The animals were randomized into group 1 (n = 8), in which the automatic device was used, and group 2 (n = 7), in which the oesophageal purse string was hand-sewn. The automatic device failed to incorporate the oesophageal mucosa and submucosa reliably into the anastomotic staple line. There were five defective anastomoses in group 1 and none in group 2 (P = 0.037). Anastomotic bursting pressures were significantly reduced in group 1 compared with group 2 (median (range) 47 (22-110) versus 82 (68-88) mmHg, P = 0.032). Within group 1, a significant difference in bursting pressure existed between complete anastomoses and those in which the mucosa was not fully incorporated (median (range) 75 (60-110) versus 39 (22-50) mmHg, P = 0.037). Median (range) breaking strengths where anastomoses were incomplete were lower than where all layers were incorporated (1420 (1250-2220) versus 1990 (1590-2475) g/cm, P = 0.009). This study questions the safety of the automatic purse-string device for oesophageal anastomosis when used in accordance with present recommendations. Further evaluation and possibly modification of either the instrument design or the methods recommended by the manufacturer for its use are warranted.

UI MeSH Term Description Entries
D008297 Male Males
D011183 Postoperative Complications Pathologic processes that affect patients after a surgical procedure. They may or may not be related to the disease for which the surgery was done, and they may or may not be direct results of the surgery. Complication, Postoperative,Complications, Postoperative,Postoperative Complication
D011312 Pressure A type of stress exerted uniformly in all directions. Its measure is the force exerted per unit area. (McGraw-Hill Dictionary of Scientific and Technical Terms, 6th ed) Pressures
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D004947 Esophagus The muscular membranous segment between the PHARYNX and the STOMACH in the UPPER GASTROINTESTINAL TRACT.
D000714 Anastomosis, Surgical Surgical union or shunt between ducts, tubes or vessels. It may be end-to-end, end-to-side, side-to-end, or side-to-side. Surgical Anastomosis,Anastomoses, Surgical,Surgical Anastomoses
D000818 Animals Unicellular or multicellular, heterotrophic organisms, that have sensation and the power of voluntary movement. Under the older five kingdom paradigm, Animalia was one of the kingdoms. Under the modern three domain model, Animalia represents one of the many groups in the domain EUKARYOTA. Animal,Metazoa,Animalia
D013270 Stomach An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the ESOPHAGUS and the beginning of the DUODENUM. Stomachs
D013528 Surgical Staplers Fastening devices composed of steel-tantalum alloys used to close operative wounds, especially of the skin, which minimizes infection by not introducing a foreign body that would connect external and internal regions of the body. (From Segen, Current Med Talk, 1995) Stapler, Surgical,Staplers, Surgical,Surgical Stapler
D013536 Suture Techniques Techniques for securing together the edges of a wound, with loops of thread or similar materials (SUTURES). Suture Technics,Suture Technic,Suture Technique,Technic, Suture,Technics, Suture,Technique, Suture,Techniques, Suture

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