PDF(Pubmed)
Abstract：
OBJECTIVE: Gastrointestinal disorders frequently necessitate surgery involving intestinal resection and anastomosis formation, potentially leading to severe complications like anastomotic leakage (AL) which is associated with increased morbidity, mortality, and adverse oncologic outcomes. While extensive research has explored the biology of anastomotic healing, there is limited understanding of the biomechanical properties of gastrointestinal anastomoses, which was aimed to be unraveled in this study.
METHODS: An ex-vivo model was developed for the biomechanical analysis of 32 handsewn porcine end-to-end anastomoses, using interrupted and continuous suture techniques subjected to different flow models. While multiple cameras captured different angles of the anastomosis, comprehensive data recording of pressure, time, and temperature was performed simultaneously. Special focus was laid on monitoring time, location and pressure of anastomotic leakage (LP) and bursting pressures (BP) depending on suture techniques and flow models.
RESULTS: Significant differences in LP, BP, and time intervals were observed based on the flow model but not on the suture techniques applied. Interestingly, anastomoses at the insertion site of the mesentery exhibited significantly higher rates of leakage and bursting compared to other sections of the anastomosis.
CONCLUSIONS: The developed ex-vivo model facilitated comparable, reproducible, and user-independent biomechanical analyses. Assessing biomechanical properties of anastomoses offers an advantage in identifying technical weak points to refine surgical techniques, potentially reducing complications like AL. The results indicate that mesenteric insertion serves as a potential weak spot for AL, warranting further investigations and refinements in surgical techniques to optimize outcomes in this critical area of anastomotic procedures.
METHODS: An ex-vivo model was developed for the biomechanical analysis of 32 handsewn porcine end-to-end anastomoses, using interrupted and continuous suture techniques subjected to different flow models. While multiple cameras captured different angles of the anastomosis, comprehensive data recording of pressure, time, and temperature was performed simultaneously. Special focus was laid on monitoring time, location and pressure of anastomotic leakage (LP) and bursting pressures (BP) depending on suture techniques and flow models.
RESULTS: Significant differences in LP, BP, and time intervals were observed based on the flow model but not on the suture techniques applied. Interestingly, anastomoses at the insertion site of the mesentery exhibited significantly higher rates of leakage and bursting compared to other sections of the anastomosis.
CONCLUSIONS: The developed ex-vivo model facilitated comparable, reproducible, and user-independent biomechanical analyses. Assessing biomechanical properties of anastomoses offers an advantage in identifying technical weak points to refine surgical techniques, potentially reducing complications like AL. The results indicate that mesenteric insertion serves as a potential weak spot for AL, warranting further investigations and refinements in surgical techniques to optimize outcomes in this critical area of anastomotic procedures.
摘要：
目的：胃肠道疾病经常需要包括肠切除和吻合形成的手术，可能导致严重的并发症，如吻合口漏（AL），这与发病率增加有关，死亡率,和不良的肿瘤学结果。虽然广泛的研究已经探索了吻合口愈合的生物学，对胃肠吻合的生物力学特性了解有限，旨在在这项研究中展开。
方法：开发了一种离体模型，用于对32只手工缝合的猪端对端吻合进行生物力学分析，使用中断和连续缝合技术受到不同的流动模型。虽然多台摄像机拍摄了吻合的不同角度，全面的压力数据记录，时间,和温度同时进行。特别注重监测时间，吻合口漏（LP）的位置和压力以及破裂压力（BP）取决于缝合技术和流量模型。
结果：LP的显着差异，BP,和时间间隔是根据流量模型而不是所应用的缝合技术进行观察的。有趣的是,与吻合的其他部分相比，肠系膜插入部位的吻合显示出明显更高的渗漏和破裂率。
结论：开发的离体模型促进了可比性，可重复,和独立于用户的生物力学分析。评估吻合的生物力学特性在识别技术弱点以完善手术技术方面具有优势。有可能减少像AL这样的并发症。结果表明，肠系膜插入是AL的潜在弱点，保证手术技术的进一步研究和改进，以优化吻合程序这一关键领域的结果。
方法：开发了一种离体模型，用于对32只手工缝合的猪端对端吻合进行生物力学分析，使用中断和连续缝合技术受到不同的流动模型。虽然多台摄像机拍摄了吻合的不同角度，全面的压力数据记录，时间,和温度同时进行。特别注重监测时间，吻合口漏（LP）的位置和压力以及破裂压力（BP）取决于缝合技术和流量模型。
结果：LP的显着差异，BP,和时间间隔是根据流量模型而不是所应用的缝合技术进行观察的。有趣的是,与吻合的其他部分相比，肠系膜插入部位的吻合显示出明显更高的渗漏和破裂率。
结论：开发的离体模型促进了可比性，可重复,和独立于用户的生物力学分析。评估吻合的生物力学特性在识别技术弱点以完善手术技术方面具有优势。有可能减少像AL这样的并发症。结果表明，肠系膜插入是AL的潜在弱点，保证手术技术的进一步研究和改进，以优化吻合程序这一关键领域的结果。
