P-0265 - The first results of a new anastomosis technique, anastomose covered by different types of meshes

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Gastrointestinal Cancers
Surgery and/or Radiotherapy of Cancer
Presenter Aybala Agac Ay
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors A. Agac Ay1, V. Sozen2, A. Ay3, S. Yanık4, E. Daphan Cagatay5
  • 1Department Of General Surgery, Kirikkale University School of Medicine, Kirikkale/TR
  • 2Kirikkale University School of Medicine, Department of General Surgery, Kirikkale/TR
  • 3Kirikkale Yuksek Ihtisas Hospital, Department of General Surgery, Kirikkale/TR
  • 4Iskenderun State Hospital, Department of Pathology, Hatay/TR
  • 5Kirikkale University, School of Medicine, Department of General Surgery, Kirikkale/TR

Abstract

Introduction

Anostomotic leakage in colorectal surgery is still one of the major issues of colorectal surgery and medical oncology. This major complication can be lethal or it can results with delayed adjuvant chemotherapy treatment. It is even more significant problem for definitive surgery after neo-adjuvant chemotherapy. In this study we investigated a new anostomosis technique with mesh covered anostomosis in different types of meshes on preventing anastomotic leakage (1-3).

Methods

Research conducted on thirty male wistar albino rat. The rats divided into 3 groups. First of all, an incision on the antimesenteric side of sigmoid colon performed in both groups an a single layer of anostomosis was made with 000 polypropylene suture. In group 2 and 3, polypropylene (polymesh®, Betatech Medical Co., İstanbul) and dual meshes (polymesh-dual®, Betatech Medical Co., İstanbul) adapted as long as the anastomosis and with a width of 2 cm was used to cover the anastomosis. The mesh was fixed on the anastomosis with the help of a few anastomotic sutures. All rats were sacrificed on the 10th postoperative day and the explosion pressure of the anastomosis, macroscopic and histopathological investigation (with Erlich-Hunt classification) of the anastomotic contour, and peritoneal adhesion (with Zuhlke and Linsky classifications) were compared. Group 1: Colonic Anastomosis; Group 2: Colonic anostomosis covered by polypropylene mesh; Group 3: Colonic anostomosis covered by dual mesh.

Results

The explosion pressure of Group 1 was significantly lower then Group 2 and Group 3 (p<0.05) but there was no significant difference between Group 2 and Group 3 (p>0.05). Additionally when histopathological investigation of the anastomotic contour considered there was a significant difference between anostomotic healing scores of Group 1 and Groups 2-3 in favour of Groups 2 and 3 (p<0.05). There was no significant difference between Group2 and Group 3 (p>0.05). When compared with peritoneal adhesions, Group 2 showed significantly higher peritoneal adhesions against Group 1 and Group 3 (p > 0.05). There was no significant difference between Groups 1 and 3 (p > 0.05).

Conclusion

In the light of our study, we think that using dual mesh to cover the anostomosis can be considered in some selected and complicated cases to give a significant strength to anastomose. Although the effects of anostomotic improvement is similar in both polypropylene and dual mesh groups, when the reduced peritoneal adhesion effect of dual mesh considered we think that it can be the most reasonable alternative to use in colonic anostomoses. Further studies needed in new anastomose techniques.