Reinforcement of colonic anastomoses with a laser and dye-enhanced fibrinogen

N. Moazami, M. C. Oz, L. S. Bass and M. R. Treat
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY.

The incidence of anastomotic leakage in colonic surgery is approximately 10%. We evaluated a technique of laser-fibrinogen reinforcement to strengthen experimental colonic anastomoses. The technique consisted of the topical application of indocyanine green dye-enhanced fibrinogen to the serosal surface of two-layer inverting anastomoses, followed by exposure with an 808-nm diode laser. In the 28 rabbits used for this study, mean bursting pressure at time 0 was 108 +/- 13 mm Hg in the group receiving anastomoses with sutures alone and 173 +/- 20 mm Hg in the group for which the sutured anastomosis was reinforced with laser-fibrinogen. The difference in bursting pressures between the two groups was statistically significant at time 0. However, at 1, 3, 5, and 7 days, the anastomosis became stronger in both groups and the difference in strength was reduced; the sutured group had more exceptionally weak (less than 110 mm Hg) bonds than the group treated by laser. Thus, laser-fibrinogen reinforcement significantly enhances the early strength of sutured colonic anastomoses. This technique may reduce the incidence of leakage during the first postoperative week and the associated complications in a clinical setting.