Improved healing of extraperitoneal intestinal anastomoses in the early phase when surrounded by omentum.
BACKGROUND
The extra-anatomical position of a cervical oesophagogastrostomy is a reason for impaired anastomotic healing, but transposition of the omentum that is covered with mesothelial cells may be a way to improve that.


METHODS
This hypothesis was tested in a rat model. An end-to-end jejuno-jejunostomy was placed subcutaneously in group I (n = 29), subcutaneously surrounded by omentum in group II (n = 29) and intra-abdominally surrounded by omentum in group III (n = 20). After 3, 7 or 14 days, the rats were sacrificed and bursting pressure (BP) of the anastomosis or jejunum was measured and the hydroxyproline (HP) level was determined.


RESULTS
In group I 5/29, in group II 2/29 and in group III 0/20 rats died following anastomotic leakage (nonsignificant) and were excluded from other measurements. BP was decreased after 3 days in group I (60+/-9 mm Hg) compared with group II (101+/-8 mm Hg) and group III (107+/-11 mm Hg) (p = 0.002). After 7 days, BP in groups I (122+/-10 mm Hg) and II (132+/-10 mm Hg) were lower as compared with group III (230+/-8 mm Hg) (p<0.001). Differences in HP levels were not statistically significant between the groups after 3, 7 and 14 days.


CONCLUSIONS
The healing of intestinal anastomoses in an extraperitoneal position is improved in the early phase only when surrounded by omentum.
Pierie
J P
JP
Department of Surgery, University Medical Center, Utrecht, The Netherlands. j.p.e.n.pierie@chir.azu.nl
de Graaf
P W
PW
van Dijk
M
M
Renooij
W
W
van Vroonhoven
T J
TJ
Obertop
H
H
D000714:Anastomosis, Surgical; D000818:Animals; D005260:Female; D007582:Jejunostomy; D008297:Male; D023421:Models, Animal; D009852:Omentum / Q000637:transplantation*; D051381:Rats; D017208:Rats, Wistar; D014945:Wound Healing