gms | German Medical Science

Background: To assess the value of the LigaSure™ Vessel Sealing System (LVSS) as a means for bowel transection and intestinal anastomosis.

Materials and methods: We compared the LVSS for 1) transecting bowel and 2) creation of an intestinal anastomosis with standard methods such as stapler (S) and hand-suture (HS) in a porcine model. For each study arm, i.e. bowel transection and anastomosis creation, both small bowel and colon were examined. In total, 10 transections and 10 anastomosis were performed for each. Burst and anastomotic leak pressures were compared.

Results: In the study arm 1, LVSS achieved lowest burst pressures in both small bowel (LVSS 39.8±3.6mmHg, S 81.9±3.9, HS 111.9±14.7mmHg, p<0.0001) and colon transection (LVSS 21.5±2.6mmHg, S 79.5±4.9, HS 91.0±5.2mmHg, p<0.0001). There was no difference in burst pressures between S and HS in both small bowel and colon transection. In the study arm 2, LVSS showed the lowest anastomotic leak pressures for small bowel (LVSS 26.4±2.6mmHg, S 52.1±6.2, HS 87.4±7.0mmHg, p<0.0001) and colonic anastomoses (LVSS 16.9±1.3mmHg, S 55.9±4.3, HS 74.4±4.4mmHg, p<0.0001). There was no difference in anastomotic leak pressures between S and HS in both small bowel and colonic anastomoses.

Conclusion: The LVSS achieves significantly lower burst pressures and anastomotic leak pressures for bowel transection and intestinal anastomosis than S and HS techniques. However, due to the achieved pressure levels of 39.8±3.6mmHg, LVSS appears to be a sufficient stand-alone method for bowel transection. Whether it can be used to perform intestinal anastomosis warrants further research in a survival model.

Figure 1 [Fig. 1]