Initial continence testing of sleeved monolayer colonic anastomoses in sheep. A comparative bench study

It has been said that the most important cause of morbidity and mortality in surgery of the colon, rectum, and esophagus is dehiscence. The new method of anastomosis tested here immediately after its completion is a sleeved continuous monolayer anastomosis with full-thickness proximal bowel joined to the mucosa and submucosa of distal bowel. The 3 to 5-mm sleeve of distal seromuscularis fashioned by prior excision of a ring of distal mucosa is folded over the monolayer anastomosis and tacked on to proximal seromuscularis by a second continuous suture. In this bench study, sleeved seromuscularis monolayer anastomoses were compared for immediate ability to withstand air distention with conventional all-layer continuous and interrupted monolayer anastomoses. The results, even in fresh nonliving bowel, suggest that there may be benefits from sleeving monolayer anastomoses in vivo. It is noted that in the newly fashioned anastomosis, through-the-suture leaks were common on progressive distention, but were observed at higher pressures in sleeved and in extramucosal suture lines than in full-thickness monolayers.