Experimental research of stent anastomosis of gastrojejunostomy in a porcine model.

Background: Gastrojejunostomy is one of the most frequently used procedures for general surgeons. The creation of anastomosis between various parts of the gastrointestinal tract is a basic technical component and major task in the daily practice of almost all gastrointestinal procedures. This research evaluated a new procedure of making gastrointestinal anastomosis with stent.

Methods: Twenty experimental mini-pigs were randomized into two groups. In stent anastomosis group (SA), the anastomoses were constructed with a poly-levolactic acid stent. In hand-sewn group (HA), the anastomoses were performed with a single-layer continuous suture. Abdominal X-ray with intraluminal contrast was performed on the 10th postoperative day. Five pigs of each group were sacrificed on the postoperative days 3 and 14 to determine anastomotic bursting pressure in situ, hydroxyproline concentration, and histopathological evaluation of the anastomotic sites.

Results: There was no intraoperative morbidity or mortality. The median time needed for the sutured anastomosis was (21.7 ± 2.3) minutes and for the stent anastomosis was (11.9 ± 1.9) minutes (P < 0.001). Abdominal X-ray with intraluminal contrast demonstrated normal gas distribution and showed no evidence of leakage or obstruction. Macroscopic appearance at the longitudinal opening of anastomosis was always good in both groups. The median anastomotic bursting pressure was (18.2 ± 1.6) kPa in SA group on postoperative day 3, compared with (11.7 ± 3.2) kPa in HA group (P = 0.003). The anastomotic bursting pressure on day 14 was not significantly different between SA group ((27.1 ± 2.6) kPa) and HA group ((28.3 ± 1.7) kPa) (P = 0.388). The hydroxyproline concentrations were not significantly different.

Conclusions: The stent anastomosis was not considered to be more difficult than a sutured anastomosis. This method is proved to be safe and feasible compared with the traditional hand-sewn method in the porcine model. The method increases early anastomotic strength in this study.