Ex vivo comparison of leakage pressures and leakage location with a novel technique for creation of functional side-to-side canine small intestinal anastomoses

Objective: To determine the ability of functional side-to-side small intestinal anastomoses (FSS-SIA) created with an electrothermal bipolar vessel sealing (EBVS) device to resist leakage. Study design: Experimental, ex vivo. Sample population: Jejunal segments (n = 130) from 10 healthy canine cadavers. Methods: Four types of anastomoses were created (two segments/construct and 15 constructs/group): EBVS (group A), EBVS + transverse stapling (group B), stapled (group C), and EBVS + suture augmentation (group D). Initial leakage pressure (ILP), initial leakage location (ILL), and maximal intraluminal pressure were compared between groups, and five group A constructs were analyzed histologically. Results: Initial leakage pressure was greater in group D than in groups A, B, and C (P <.011). There was a difference in ILL among groups (P =.003). Leakage occurred at the side-to-side intestinal anastomosis fusion line in 13 of 15 (87%) constructs for groups A and B and in nine of 15 (60%) constructs for group D. Maximal intraluminal pressure was greater in group C than in groups A, B, and D (P <.004). Histological examination was consistent with collagenous fusion without cavitation defects. Conclusion: Functional side-to-side small intestinal anastomosis was consistently achieved with an EBVS device. Augmentation of EBVS anastomoses with simple interrupted sutures along the anastomotic fusion line increased ILP compared with stapled anastomoses. Clinical significance: Despite the success and feasibility of creating an FSS-SIA with an EBVS device, additional in vivo studies are required to determine the effectiveness of intestinal fusion prior to clinical implementation.