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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546


FERNANDES NETO, Francisco Américo et al. Experimental comparative study of esophagogastric stenosis in manual and mechanic sutures. Rev. Col. Bras. Cir. [online]. 2000, vol.27, n.2, pp.72-81. ISSN 1809-4546.

Twenty eight pigs were randomly distributed to two groups of 14 animals ("A" and "B"). Cardia's anatomic diameter was mouldred and measured with a small latex balloon filled with alginato injection. The animals were then submitted to an esophagogastric section. In group "A", anastomosis was performed with separated sutures using 910 poliglactina "000" and in the group "B" the suture was performed with ILS stapler. Seven pigs, from both subgroups "A1" and "B1", were submitted to a new operation and evaluated after seven days while two other sub-groups from seven animals each ("A2" and "B2") had the operation on the 14th day. The anatomic parts were macroscopically examined, followed by a pressure test, histological study and the identification and measurement moulds. The medial percentual difference of stenosis (delta P), was evaluated by the media of the cardias' diameter before and after manual and mechanics suture. Statistical analysis showed that there is no significant percentual media difference of stenosis and operative time ("deltas Ps"). The "delta P" stenosis in the manual suture was 25,44% at the 7th postoperative day and 15,88% at the 14th postoperative day. In the mechanics suture the percentual on the 7th and 14th day were 22,80% and 23,04%. The stenosis did not cause any trouble to the esophagogastric alimentary transit. Macroscopically, there were no free leakage observed in the abdominal cavity, although the microscopic evaluation showed a blocked partial suture ruptures in three animals. Adesions were more prevalent with manual sutures. A bad coaptation between visceral edges of the anastomosis in a few clippings resulted in a fibriform reparation with areater stenosis. Regarding hand made sutures, more perianastomotic inflamatory changes were observed in this subset of animals, while the stapling of the anastomosis lowered angiogenesis. The present study may have demonstrated that manual and mechanical sutures, if not ideal are at least, satisfactory and have considerable quality when they are performed with minimal trauma, good hemostasis, preservation of the blood irrigation, infection control, choice of the appropiated suture material or the most suitable stapler with good coaptation of the visceral edges.

Keywords : Esophagogastric stenosis; manual and mechanic sutures.

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