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Comparison of simple interrupted Gambee and crushing techniques for intestinal anastomosis in cattle

Author: Mbiuki, Stanley Mbaka

Awarding University: University of Nairobi, Kenya

Level :

Year: 0

Holding Libraries: National Council for Science and Technology Library ; University of Nairobi Upper Kabete Library ;

Subject Terms: Comparative studies ; Intestinal anastomosis ; Animal care ; Cattle ;


End-on approximating techniques for intestinal anastomosis have been found to be more advantageous than everting and inverting techniques by different- investigators. The simple interrupted, gambeeand crushing anastomotic techriiques whEfn evaluated independently have usually been found to be superior to the techniques with which they were compared. Comparison of simple interrupted, gambee and crushing techniques together have not been previously reported. The purpose of -: this investigation .is to make a comparative study of the simple interrupted, gambee and crushing approximating techniques as used for intestinal anastomosis in cattle. Twenty four male cattle were used to perform anastomoses in the small intestine utilizing simple interrupted, gambee and crushing techniques for comparative studies. Six anastomoses were performed in each of 8 animals using any one of the techniques to make a total of 48 anastomoses per technique. Therefore one hundred fourty four anastomoses were performed using the three techniques. Evaluation'procedures were carried out at 4, 14, 28 and 56 days post-operatively to assess -c the efficacy of the respective techniques. Parameters investigated were: time per anastomosis and per stitch, adhesion formation,- stenosis (external and internal) and histopathologic changes. From the histologic sections, epitbelializati~n, inflammatory reaction, muscle layer approximation, cellular intensity and cell types were evaluated. I~crease in-thickness of anastomotic site relative to the adjacent and normal areas were also evaluated. Results of adhesion formation, external stenosis, epithelialization, inflammatory reaction, and muscle layer approximation were given numerical scores to make the comparison objective and easier to visualize. The results showed that time per suture was found to be a more reliable indicator of the time taken to perform an intestinal anastomosis. The simple interrupted technique took the least mean time per suture (36~6 sec.) followed by gambee technique (49.5 sec.) and crusbing technique was last with 57.4 seconds. There were no adhesions in 11% .of gambee' anastomoses, 58%.of crushing anastomoses and ? 21% of simple interrupted anastomoses. This clearly demonstrated gambee as the technique that induces least adhesions. Stenosis as seen externally was absent in 62% of gambee anastomoses, 531 of simple interrupted anastomoses and 40% o~ crushing anastomoses indicating that gamhee was a better technique in this regard. Luminal stenosis evaluated 1rom radio- graphs showed a mean narrowing o~ 30.6% in gambee anastomoses, 36% in simple interrupted anastomoses and 38.9% in crushi'I1? anastomoses, thus implying gambee was a superior technique. Epithelial healing was more or less complete at 4 days in simple in~errupted anastomoses followed by gambeeoastomoses with crushing anastomoses having poor epithe lia1 healing. However at 14 days. the healing in the crushing anastomoses overtook that in the other techniques. Simple interrupted anastomoses were inferior in the epithelial bealing to the anastomoses performed us i ng the other two techniques at 14 days. After 14 days all the anastomoses showed a similar degree of epithelial healing . Overall, gambee anastomoses had a slightly better epithelial he~ling than the other two techniques. Generally, inflammatory reaction decreased with time. There was a greater decrease in gambee anastomoses followed by crushing ana- stomoses and simple interrupted anastomoses? showed the greatest inflammatory reaction. Muscle layer approximation apparently did not change with time but remained as it was after anastomosis for all techniques. However, gambee anastomoses showed the best alignment followed by crushing anastomoses and simple interrupted anastomoses had least efficacy in alignment of the muscle layer. Cellular intensity was high in all the techniques at 4 days due to the increased number of cells in the early proliferative phase and late lag