Abstract
Introduction: Our studies of clipped intestinal non-perforating anastomosis (CINPA) of the small
bowel in a rat model have demonstrated that all clips migrated from the outside to
the inside of the small bowel during the healing process. The aim of this study was
to describe how the clips migrate.
Material and Methods: In male Sprague Dawley rats small bowel anastomoses were performed with single, non-perforating
metal clips. Bowel specimens were obtained from the anastomosed region for histological
examination.
Results: On the day of surgery all clips were situated in the serous membrane. On the first
postoperative day, an intramural migration could be observed. By days 6, 8, and 10
no clip was found in the peritoneum. All egested clips were found either in the distal
lumen of the bowel or in the solid feces. H&E staining of the anastomoses studies
indicated that the bowel wall everts immediately after being cut and becomes more
and more inverted during the first few days after being anastomosed.
Conclusion: Our studies showed that the observed dynamic movement of the bowel wall determines
the movement of clip migration from the serosal to the mucosal side of the small bowel.
In pediatric surgery the observed clip migration would be an important precondition
for employing clipped intestinal non-perforating anastomosis (CINPA) routinely. However,
further studies are necessary before the technique can be applied in daily practice.
Key words
clipped anastomosis - clip migration - small bowel
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Correspondence
Priv. Doz. Dr. Bernhard Rumstadt
Fuerst Stirum Hospital Bruchsal,
Surgery
Gutleutstrasse 1–14
76646 Bruchsal
Germany
Phone: +49/7251/708 5801
Fax: +49/7251/708 5802
Email: bernhard.rumstadt@kliniken-lk.de
