| dc.description.abstract | End-on approximating techniques for
intestinal anastomosis have been found to be
more advantageous than everting and inverting
techniques by different investigators. The
simple interrupted, gambee and crushing
anastomotic techniques when evaluated independently
have usually been found to be superior
to the techniques with which they were
compared. Comparison of simple interrupted,
gambee and crushing techniques together have
not been previously reported. The purpose of
this investigation is to make a comparative
study of the simple interrupted, gambee and
crushing approximating techniques as used for
intestinal anastomosis Ln cattle.
Twenty four male cattle were used to
perform anastomoses in the small intestine
utilizing simple interrupted, gambee and
crushing techniques for comparative studies.
Six anastomoses were performed in each of 8
animals using anyone of the techniques to
mnke a total of 48 anastomoses per technique.
Therefore one hundred fourty four anastomoses
were performed using the three techniques.
Evaluation procedures were carried out at 4,
14, 28 and 56 days post-operatively to assess
the efficacy of the respective techniques.
Parameters investigated were: time
per anastomosis and per stitch, adhesion
formation, stenosis (external and internal)
and histopathologic changes. From the
histologic sections, epithelia]ization,
inflammatory reaction, muscle layer approximation,
cellular intensity and cell types
were evaluated. Increase in thickness of
anastomotic site relative to the adjacent and
normal areas were also evaluated.
Results of adhesion formation, external
stenosis, epithelialization, inflammatory
reaction, and muscle layer approximation were
given numerical scores to make the comparison
objective and easier to visualize.
The results showed that time per suture
was found to be a more reliable indicator
of the time taken to perform an intestinal
anastomosis. The simple interrupted tech-.
nique took the least mean time per suture
(36.6 sec.) f oLlowe d by gambee technique
(49.5 sec.) and crushing technique was last
with 57.4 seconds.
There were no adhesions in 77% of gambee'
anastomoses, 58% of crushing anastomoses and
27% of simple interrupted anastomoses. This
clearly demonstrated gambee as the technique
that induces least adhesions.
Stenosis as seen externally was absent
in 62% of gambee anastomoses, 53% of simple
interrupted anastomoses and 40% OI crushing
anastomoses indicating that gambee was a
better technique in this regard.
Luminal stenosis evaluated :from radiographs
showed a mean .narrowing of 30.6% in
gambee anastomoses, 36% in simple interrupted
anastomoses and 38.9% in crushing anastomoses,
thus implying gambee was a superior technlque.
Epithelial healing was more or less
complete at 4 days in simple interrupted
anastomoses followed by gambee anastomoses
with crushing anastomoses having poor epithelial
healing. However, at 14 days, the
healing.in the crushing anastomoses overtook
that in the other techniques. Simple inter-
anastomoses were inferior in the epithelial
healing to the anastomoses performed
using the other two techniques at 14 da~s.
After 14 days all the anastomoses showed a
similar degree of "epitheliql healing.
Overall, gambee anastomoses had a slightly
better epithelial healing than the other two
techniques.
Generally, inflammatory reaction decreased
with time. There was a greater decrease in
gambee anastomoses followed by cru hing anastomoses
and simple interrupted anastomoses
showed the greatest inflammatory reaction.
Muscle layer approximation apparently
did not change with time but remained as it
was after anastomosis for all techniques.
However, gambee anast0moses showed the best
alignment followed by crushing anastomoses
and simple interrupted anastomoses had least
efficacy in alignment of the muscle layer.
Cellular intensity was high in all the
techniques at 4 days due to the increased
number of cells in the early proliferative
phase and late lag phase. The higher cell
counts
at 56 days were due to wound pontraction
in the maturation phase. Cellular intensity
was lowest at 28 days. Gmnbee
anastomoses had the least cellular intensity
followed by crushLng anastomoses, with simple
interrupted anastomoses having the highest
cellular intensity probably due to the
attendant greater inflammatory reaction.
All the 7 cell types observed were
present in the 3 types of anastomosis
regardless of technique used. None of the
techniques had any cell in great excess of
what was expected at various time intervals.
The cell types were therefore not important
in the comparative evaluation.
The index of increase in thickness was
developed for this investigation. None of
the techniques had any greater index of
thickness than the other. However the coefficient
of increase in thickness, demonstrated
that gambee anastomoses had the least
spread of increase in thickness followed by
crushing anastomoses. Simple interrupted
anastomoses had the most widely spread
increase in thickness.
Generally, gambee technique showed
superior qualities. Crushing technique was
second and simple interrupted was last. | en |
