Impact of Surgical Experience on Burst Pressure of Hand-Sewn and Stapled Anastomoses

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2025-04-24 DOI:10.1016/j.jss.2025.03.063

Thomas M.R. McKinley MD , David Chow MD , Jonathan B. Livezey MD , Andrew Anklowitz MD , Taylor M. Williams MD , Tiffany Kippenberger DO , Byron J. Faler MD , Marcos C. Aranda MD

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引用次数: 0

Abstract

Introduction

Both hand-sewn and stapled techniques for creating small bowel anastomoses are safe and have similar rates for leaks and stricture. Each technique comes with its own benefits and detriments, but a well-trained surgeon should be proficient in both anastomotic techniques. The understanding of tissue layers and meticulous technique needed to perform a proper hand-sewn anastomoses require greater skill and experience than a stapled anastomosis to achieve comparable results. This study is aimed to determine if there is a difference in anastomotic burst pressure between hand-sewn versus stapled anastomoses when they were performed by surgeons with differing years of experience.

Methods

Attending and resident surgeons with varying experience followed standardized instructions to create a hand-sewn and stapled anastomosis using segments of swine small intestine. Burst pressure was measured by inflating the intestine with air and using a manometer to record the pressure at which air leaked from the anastomosis.

Results

Thirteen participants with 1-11 y of experience took part in this study. Burst pressure ranged between 4 and 76 mmHg for hand-sewn and 9 to 40 mmHg for stapled anastomoses. The mean burst pressures of stapled anastomoses were equal between less (mean = 29.0 mmHg, standard deviation [SD] = 8.54) and more (mean 29.0 mmHg, SD = 12.36) experienced surgeons. The difference in mean burst pressure of hand-sewn anastomoses for less experienced surgeons (mean = 34.6 mmHg, SD = 21.8) and more experienced surgeons (mean = 24.8 mmHg, SD = 5.26) was not statistically significant (P = 0.09). However, there was a significant difference between the SDs of the hand-sewn anastomoses of less and more experienced surgeons (P = 0.01, F = 17.1, F Crit = 9.2). There was no significant difference in our secondary outcome, mean burst pressure between hand-sewn 30.5 mmHg (SD = 18.4) and stapled anastomoses 29.0 mmHg (SD = 11.07) (P = 0.81).

Conclusions

While unable to detect differences regarding the impact of surgical experience on mean burst pressure of anastomoses, there is a greater range of burst pressures in the hand sewn group. In addition, we feel that the model of anastomotic testing we present represents the value, at all levels of training, of refining and practice advanced surgical technical skills on animal models.

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手术经验对手缝吻合器破裂压力的影响

手工缝合和吻合器技术都是安全的，并且具有相似的泄漏和狭窄率。每一种技术都有自己的优点和缺点，但一个训练有素的外科医生应该精通这两种吻合技术。对组织层的理解和细致的技术需要进行适当的手工缝合吻合术需要比钉接吻合术更高的技能和经验，以达到类似的结果。本研究的目的是确定当由不同经验的外科医生进行手工缝合与吻合器吻合时，吻合口破裂压力是否存在差异。方法不同经验的主治医师和住院医师按照标准化的指导使用猪小肠段进行手工缝合吻合术。破裂压力是通过向肠道充气，并使用压力计记录空气从吻合口泄漏的压力来测量的。结果13名1-11年经验的参与者参加了本研究。手缝吻合器的破裂压力范围为4至76毫米汞柱，吻合器的破裂压力范围为9至40毫米汞柱。经验较少（平均为29.0 mmHg，标准差[SD] = 8.54）与经验较多（平均为29.0 mmHg, SD = 12.36）的吻合口平均破裂压力相等。经验较浅术者（平均= 34.6 mmHg, SD = 21.8）与经验较丰富术者（平均= 24.8 mmHg, SD = 5.26）手缝吻合口平均破裂压力差异无统计学意义（P = 0.09）。经验较浅术者与经验较丰富术者手工缝合吻合的SDs差异有统计学意义（P = 0.01, F = 17.1, F Crit = 9.2）。我们的次要结局，手工缝合30.5 mmHg （SD = 18.4）和吻合器29.0 mmHg （SD = 11.07）的平均破裂压无显著差异（P = 0.81）。结论手术经验对吻合口平均破裂压力的影响虽无差异，但手缝组的破裂压力范围更大。此外，我们认为，我们提出的吻合口测试模型代表了在各级培训中，在动物模型上完善和实践先进的外科技术技能的价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.