Comparison of two closure techniques for the repair of experimental colonic perforations

Background: Primary repair of penetrating wounds of the colon is gaining increasing acceptance in surgical practice. This study compared two techniques for the repair of experimental colonic perforations in the presence of peritonitis. Methods: Multiple colonic perforations were created in the colon of 24 pigs. Following a 6-h delay the perforations were closed either by local excision and suture or by skin staples applied to the seromuscular layers of the colon. The repairs were assessed biomechanically and histologically for up to 14 days after surgery. Results: All animals had diffuse peritonitis at the time of colonic repair. Stapled repairs were completed significantly faster than sutured repairs (mean(s.d.) 4.8(1.6) versus 30.7(4.0) min, P < 0.001). Biomechanical evaluation of repairs revealed no significant differences between the two techniques. Histological examination of repairs closed by staples demonstrated more advanced healing compared with suture closure, on the basis of tissue apposition and inflammatory changes. Conclusion: Experimental colonic injuries may be treated successfully by primary repair in the presence of peritonitis. The use of skin staples for repair does not appear to prejudice colonic wound healing.