Colonic Anastomosis in the Presence of Fecal. Peritonitis Using a Disposable Skin Stapler

Abstract

The purpose of this study was to determine if the method of intestinal anastomosis used by British military surgeons for the management of small bowel injuries could be used to manage colonic trauma when fecal peritonitis may be present. Anastomoses were performed using skin staples in lieu of sutures in pig colons in the presence of fecal contamination and early peritonitis. The times taken to complete the anastomoses were recorded. Animals were euthanatized at 2, 5, and 14 days following surgery. Healing was assessed clinically, at postmortem, and by histological examination. In addition, the anastomoses were tested for integrity by intraluminal distension with water, and for healing strength by tensiometry. The mean ± SD time taken to perform the anastomoses (n = 18) was 10.8 ± 2.8 min. There were no clinical or postmortem findings suggestive of anastomotic leakage. Only one anastomosis leaked at an intraluminal pressure of less than 100 cm H₂O. Testing of ultimate tensile strength of the colon adjacent to the anastomosis showed that the anastomotic line was significantly weaker than the proximal (p <. 05 analysis of variance, ANOVA) and distal colon (p <. 001) at 5 days and that the colon proximal to the anastomosis was weaker than the colon distally at all time points; this was statistically significant (p <. 01, ANOVA) at 5 days. These results suggest that a primary colonic skin-stapled anastomosis in the presence of fecal peritonitis is quick to perform and has a low risk of failure.

Key Words:

• colonic anastomosis
• fecal peritonitis
• military trauma
• skin staple