Comparison of simple interrupted gambee and crushing techniques for intestinal anastomosis in cattle
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.