Fahmy Youssef, Trabia Mohamed, Ward Brian, Gallup Lucas, Elks Whitney
Department of Mechanical Engineering, Howard R. Hughes College of Engineering, University of Nevada, Las Vegas, NV 89154, USA.
Department of Surgery, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89106, USA.
Bioengineering (Basel). 2025 Jun 20;12(7):676. doi: 10.3390/bioengineering12070676.
Anastomotic leaks after colorectal resection are serious surgical complications. We have compared the integrity of two common colorectal anastomosis techniques, end-to-side (ES) and end-to-end (EE), to control specimens using a novel experimental setup that mimics anastomotic air leak tests, which are typically performed during surgeries. Freshly harvested porcine colonic sections from 23 F1 cross-species pigs were used. Pressure measurements and video imaging were used to monitor the ex vivo experiments on EE, ES, and Control specimens. Using EE ( = 16), ES ( = 12), and Control ( = 22) specimens, leak pressure was 282.6 ± 3.0 mm Hg for EE, 282.8 ± 2.6 mm Hg for ES, and 294.4 ± 12.1 for the Control. Time to leakage was 106.3 ± 28.1 s for EE, 263.9 ± 2127.0 s for ES, and 194.5 ± 90.2 s for the Control. We found that, while EE and ES have nearly identical leak pressures, ES was superior in terms of time to leakage and tissue expansion, which may explain why ES anastomoses have a lower clinical anastomotic leak rate. Two dependent variables representing stress and strain of colonic tissues were introduced. These variables showed ES was comparable to the Control. The experiments were simulated successfully using the finite element method (FEM). This research provides a reproducible ex vivo system with a corresponding FEM system to study the differences between anastomosis techniques and may help design anastomoses with lower leak rates and improve patient outcomes in colorectal surgeries.
结直肠切除术后的吻合口漏是严重的手术并发症。我们使用一种模拟吻合口漏气测试的新型实验装置,比较了两种常见的结直肠吻合技术(端侧吻合和端端吻合)与对照标本的完整性,这种测试通常在手术中进行。使用了23只F1杂交猪新鲜获取的猪结肠段。压力测量和视频成像用于监测端端吻合、端侧吻合和对照标本的体外实验。使用端端吻合标本(n = 16)、端侧吻合标本(n = 12)和对照标本(n = 22),端端吻合的漏气压为282.6±3.0 mmHg,端侧吻合为282.8±2.6 mmHg,对照为294.4±12.1 mmHg。漏出时间端端吻合为106.3±28.1秒,端侧吻合为263.9±2127.0秒,对照为194.5±90.2秒。我们发现,虽然端端吻合和端侧吻合的漏气压几乎相同,但端侧吻合在漏出时间和组织扩张方面更具优势,这可能解释了为什么端侧吻合的临床吻合口漏率较低。引入了两个代表结肠组织应力和应变的因变量。这些变量显示端侧吻合与对照相当。使用有限元方法(FEM)成功模拟了实验。本研究提供了一个可重复的体外系统及相应的有限元系统,以研究吻合技术之间的差异,并可能有助于设计漏率更低的吻合方式,改善结直肠手术患者的预后。