Experimental Simulation of Compression Anastomosis in Double-Barreled Enterostomy Using a Titanium Nickelide Memory Shape Device

Abstract

Introduction. Enterostomy remains a relevant option of staged treatment of small intestine diseases in children. T-anastomosis with stoma (Bishop-Koop) and double-barreled enterostomy with compression anastomosis (Mikulicz) are among the most widely accepted ones. Disadvantages of compression anastomosis can be eliminated by using a NiTi-clip with shape memory. The aim of the study was to perform an experimental study to detect effectiveness and advantages of NiTi-clip application in formation of a compression anastomosis in a double-barreled enterostomy compared with manual T-anastomosis. Methods. The study included 24 rabbits of the "Serebristyi" breed, aged 2.5-3 months, weighed 2790-3100 g; they were divided into two equal groups. Autopsy was performed in 10, 14, 21 days with pneumopression and histological examination. Differences were considered statistically significant at p-value 0.05. Results. The duration of the Mikulicz operation (group A) was significantly shorter than that of Bishop-Koop`s (group B) (p = 0.000). Significant differences in weight were found in 14. 21 days, with a predominance in group A (p = 0.029). Complications included wound suppuration, eventration, peritonitis, evagination, dermatitis, and anastomotic leakage. In 10 days, compression anastomosis had a lower anastamotic pressure, but in 21 days, it was more stabile than in manual anastomosis (p = 0.019). In 14 days, inflammatory changes in the mucosa with fibrosis in the muscle layers and lesions were detected in the area of ​​manual anastomosis, they were accompanied by inflammation around sutures. In 21 days, fibrotic changes spread in all layers. Proliferation prevailed over inflammation in the area of ​​the compression anastomosis. Conclusions. Double-barreled stoma formation with NiTi-clip application took less time than T-anastomosis. Animals with a double-barreled stoma and compression anastomosis had a larger weight gain. Compression anastomosis with NiTi-clip in the stoma was stabile than manual anastomosis. With compression anastomosis, layer-by-layer regeneration from serous to mucous membrane occurs, healing occurred faster, with a predominance of proliferation processes, the risk of stenosis decreased. The use of NiTi-clip in the surgical treatment of children with double-barreled enterostomy can be recommended for practical use.