Tissue fusion technology versus suture and staple in porcine bowel anastomosis: an in vivo study

The aim of this study was to make a comparison between the tissue fusion technique and conventional methods for sealing bowel anastomosis. Eighteen female domestic pigs (Suidae, Sus) were used in our study. Tissue-fused anastomoses (LigaSure groups) were made in 13 animals (5 anastomoses per animal), which were subdivided into 4 groups according to different manufacturing settings: “LigaSure-L-1” and “LigaSure-L-2”, with low energy output level with 1 or 2 device-activated tissue sealing times, and “LigaSure-M” and “LigaSure-H”, with medium or high energy output level. As controls, automatically stapled (GIA group) and hand-sewn (suture group) anastomoses were utilized in 3 and 2 animals, respectively. There was no statistical difference in the overall leakage rate between the GIA group (6.7%) and the LigaSure groups (15%) (P=1.000). There was less proliferating epithelium covering the anastomosis gap in the LigaSure groups compared with the other two groups. The gap between the two extremities of muscular layers of the anastomosis in the LigaSure groups was filled with collagen fibers. More proliferating cell nuclear antigen (PCNA)-positive cells were found in the anastomoses of the LigaSure groups compared with the other two groups (P=0.010). Our results showed that the tissue fusion technology was a feasible and safe method for anastomoses.

本研究旨在对比组织融合技术与传统肠吻合口封闭方法的应用效果。本研究共使用18头雌性家猪（猪科Suidae，猪属Sus）。其中13头动物接受组织融合吻合术（LigaSure组，LigaSure groups），每头动物完成5例吻合术，根据不同的设备设置参数分为4个亚组："LigaSure-L-1"与"LigaSure-L-2"为低能量输出档位，分别执行1次或2次设备自动触发的组织密封操作；"LigaSure-M"与"LigaSure-H"分别对应中能量、高能量输出档位。对照组分别纳入3头接受自动吻合器吻合术（GIA组，GIA group）的动物，以及2头接受手工缝合吻合术（缝合组）的动物。GIA组（6.7%）与LigaSure组的总体吻合口漏发生率无统计学差异（P=1.000）。与其余两组相比，LigaSure组吻合口间隙处覆盖的增殖上皮更少。LigaSure组吻合口的肌层两端间隙可见胶原纤维填充。与其余两组相比，LigaSure组吻合组织中的增殖细胞核抗原（proliferating cell nuclear antigen，PCNA）阳性细胞数量更多（P=0.010）。本研究结果表明，组织融合技术是一种可行且安全的肠吻合术方案。