Healing of aseptic end-to-end intestinal anastomoses by the author's method.

Abstract

A study was made of specimens of 86 end-to-end anastomoses performed on dogs using a revolving tubular knife for cutting ligatures or purse-string sutures placed about the closed abutted ends of severed bowel after enterorrhaphy was practically complete. Several types of silk or catgut sutures were used. Stitches approximating the serous surfaces were laid at various distances from the occluding ligatures or purse-string sutures beyond which, at different lengths, the bowel was severed by electric cautery or by cutting and carbolizing. In some cases the serous and muscular coats were stripped back and the ligatures were placed about the submucosa or near the cut edges. The bowel was cut perpendicularly to the long axis, slightly obliquely, or at an angle of 45°.

Rapidity of healing depends upon (1) the amount of trauma or necrosis produced by severing the bowel and sterilizing the cut ends; (2) the proximity of the cut mucosal surfaces to each other at the tip of the inturn; (3) the position and length of the apposed bowel walls at the inturn; (4) the vascularity of the inturn which largely depends upon the size, type, material and tightness of the sutures, and the angle at which the bowel is severed, and (5) the amount of infection about the area of anastomosis.

Cutting and carbolizing the stumps causes less extensive trauma, necrosis and hemorrhage to the bowel wall than does cauterizing thermally although, unless proper precautions are taken, there is more chance for soiling by the former method. Stripping back a sero-muscular cuff and ligating the mucosa and submucosa hastens healing but adds an unnecessary step to the operation.

The inturned walls agglutinated by fibrinoplastic exudate by the completion of the operation and they begin to retract immediately on being freed from their normal tension.