Omental pedicle graft to improve ischemic anastomoses.
An end-to-end anastomosis was done in the center of a 5-cm devascularized jejunal segment in 5 control laboratory rabbits and 14 experimental rabbits. A second group consisted of 5 control animals and 11 experimental animals having end-to-end jejunojejunostomy in the center of a 10-cm devascularized jejunal segment. In the experimental animals, the anastomosis was wrapped circumferentially by a vascularized omental pedicle. Anastomotic leaks or fistulas developed in five 10-cm controls (100%), five 5-cm controls (100%), nine 10-cm omental wraps (82%), and four 5-cm omental wraps (29%). The remaining animals had strictures of various degrees. Injection of methylene blue into the omental vessels showed perfusion to the mucosa from the omentum. The difference between the 10-cm segment and the 5-cm segment indicates some limitation to the available blood flow from the omentum. The anastomotic stricturing was due to ischemic injury before reperfusion by ingrowth of omental vessels. A vascularized omental pedicle wrap can augment blood flow; however, the time required for neovascular ingrowth allows ischemic mucosal injury if there is no other available blood supply.
Dockendorf
B L
BL
Department of Surgery, Scott & White Clinic and Memorial Hospital, Scott, Sherwood and Brindley Foundation, Temple, TX 76508.
Frazee
R C
RC
Matheny
R G
RG
D000714:Anastomosis, Surgical; D000818:Animals; D003108:Colonic Diseases / Q000209:etiology; D007412:Intestinal Fistula / Q000209:etiology; D007511:Ischemia; D007579:Jejunal Diseases / Q000209:etiology; D007582:Jejunostomy; D007583:Jejunum / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D009389:Neovascularization, Pathologic / Q000473:pathology; D009852:Omentum / Q000637:transplantation; D011183:Postoperative Complications; D011817:Rabbits; D013524:Surgical Flaps / Q000379:methods*