Impaired healing of extraperitoneal intestinal anastomoses.
BACKGROUND
The extra-anatomical position of a cervical oesophagogastrostomy might be a reason for impaired anastomotic healing.


METHODS
This hypothesis was tested in a rat model. Jejunal resection with an end-to-end jejunojejunostomy was placed intra-abdominally in group 1 (n = 24) and subcutaneously in group 2 (n = 30). Jejunum without anastomosis was placed subcutaneously in group 3 (n = 12). After 3, 7 or 14 days the rats were killed; the bursting pressure of the anastomosis or jejunum was measured and the hydroxyproline level was determined.


RESULTS
Two of 24 rats in group 1 and eight of 30 in group 2 died following anastomotic leakage (P not significant) and were excluded from other measurements. Bursting pressure was decreased after 3 days in group 1 (mean(s.e.) 62(10) mmHg) and group 2 (57(10) mmHg) compared with that in group 3 (204(17) mmHg) (P < 0.001). After 7 days, it was in the normal range in group 1 (200(14) mmHg), but lower in group 2 (104(15) mmHg) compared with that in group 3 (230(8) mmHg) (P < 0.001). Differences in hydroxyproline levels were not statistically significant between the groups after 3, 7 and 14 days.


CONCLUSIONS
Healing of jejunojejunostomies is impaired in an extraperitoneal position compared with an intra-abdominal position.
Pierie
J P
JP
Department of Surgery, University Hospital Utrecht, Utrecht, The Netherlands.
de Graaf
P W
PW
Vroonhoven
T J
TJ
Renooij
W
W
Obertop
H
H
D000714:Anastomosis, Surgical; D000818:Animals; D005260:Female; D006909:Hydroxyproline / Q000378:metabolism; D007582:Jejunostomy / Q000379:methods; D008297:Male; D011312:Pressure; D051381:Rats; D017208:Rats, Wistar; D013529:Surgical Wound Dehiscence / Q000378:metabolism; D014945:Wound Healing
D006909:Hydroxyproline