[Technique and quality of laparoscopic hand-sewn intestinal anastomoses in an experimental procedure]

In conventional surgery running suture of all intestine layers is used commonly. Therefore we have tested the following manual running suture technics for laparoscopic surgery using animal experiments. 1. Turnover technic: suture of front and back-wall from outside by using holding sutures. 2. Non-turnover-technic: special holding sutures to fix the back-wall and sewing from the inside followed by the front-wall from outside. 3. Clamp-technic: By using two special parallel closing clamps (Endo-Gauge) with a suture from inside and outside. The ends of the anastomosis are well fixed without additional suture. All animals (n = 15) survived without complications, without leakage of the anastomosis and only one third developed intraabdominal fusions. The main difference was in time performing the anastomosis: 64 min. for the turnover technic, 52 min. for the non-turnover technic and only 25 min for the clamp technic without holding sutures. According to this results, we start to design a new bowel-clamp for sewing laparoscopic anastomosis. Therefore it is possible to perform a laparoscopic manual running suture in a reasonable amount of time. Furthermore the laparoscopic manual suture is a good alternative to the stapler technic because it is much less expensive and leaves no foreign materials.