Reinforcement of colonic anastomoses with a laser and dye-enhanced fibrinogen

The incidence of anastomotic leakage in colonic surgery is approximately 10%. We evaluated a technique of laser-fibrinogen reinforcement to strengthen experimental colonic anastomoses. The technique consisted of the topical application of indocyanine green dye-enhanced fibrinogen to the serosal surface of two-layer inverting anastomoses, followed by exposure with an 808-nm diode laser. In the 28 rabbits used for this study, mean bursting pressure at time 0 was 108 +/- 13 mm Hg in the group receiving anastomoses with sutures alone and 173 +/- 20 mm Hg in the group for which the sutured anastomosis was reinforced with laser-fibrinogen. The difference in bursting pressures between the two groups was statistically significant at time 0. However, at 1, 3, 5, and 7 days, the anastomosis became stronger in both groups and the difference in strength was reduced; the sutured group had more exceptionally weak (less than 110 mm Hg) bonds than the group treated by laser. Thus, laser-fibrinogen reinforcement significantly enhances the early strength of sutured colonic anastomoses. This technique may reduce the incidence of leakage during the first postoperative week and the associated complications in a clinical setting.