title: Improved healing of extraperitoneal intestinal anastomoses in the early phase when surrounded by omentum.
abstract: 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.
authors: Department of Surgery, University Medical Center, Utrecht, The Netherlands. j.p.e.n.pierie@chir.azu.nl
authors: J P
authors: JP
authors: Pierie
authors: P W
authors: PW
authors: de Graaf
authors: M
authors: M
authors: van Dijk
authors: W
authors: W
authors: Renooij
authors: T J
authors: TJ
authors: van Vroonhoven
authors: H
authors: H
authors: Obertop
mesh_terms: 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