Comparative study of free omental, peritonenal, Dacron velour, and Marlex mesh reinforcement of large-bowel anstomosis

Gulati, Shilpa; Thusoo, T. K.; Kakar, Atul; Iyenger, B.; Pandey, Kiran

doi:10.1007/bf02564157

Cited by 24 publications

(13 citation statements)

References 4 publications

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“…On the other hand, a study carried out in dogs found clinical leakage in 70% of the cases without any obstruction or sign of large bowel obstruction. 6 However, this model used a combination of ischemia and technically insufficient technique. Hence, it cannot be ruled out that the clinical leakage was a result of the technical insufficiency and that the degree of ischemia may have been too small to create obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Using a combination of ischemia and technical insufficiency, other models have been able to create clinical leakage, but the effect of ischemia on the colonic anastomosis alone remains unknown. 6,7 Several animal studies have evaluated healing of the anastomosis without producing clinical leakage. 8 However, since clinical leakage is a condition comparable to the human scenario, a model for this may be needed.…”

mentioning

confidence: 99%

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Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

Pommergaard

Achiam

Burcharth

et al. 2015

International Surgery

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Colon anastomotic leakage has a multifactorial etiology and ischemia is considered one of the most important single factors. However, no existing animal models have established a direct link between ischemia and anastomotic leakage. The aim of this study was to establish a model of colon anastomotic leakage as a result of tissue ischemia. In colon anastomoses of 53 C57BL/6 mice, varying degrees of ischemia were induced. Supplying vessels were divided with bipolar coagulation in order to reduce anastomotic breaking strength and create clinical anastomotic leakage. Breaking strength of all the ischemic anastomoses were significantly lower compared with controls. Increasing ischemia resulted in higher rates of large bowel obstruction without creating anastomotic leakage. Healing was compromised as a result of impaired blood supply. However, clinical leakage was absent. Pure ischemia in otherwise healthy experimental animals may be too simple of an approach to create clinical leakage.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

Pommergaard

Achiam

Burcharth

et al. 2015

International Surgery

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“…The omentum may cover a small leak in the anastomosis and provides mechanical sealing. This effect has also been attributed to artificial grafts [18]. Furthermore, it has been reported that mesothelial cells produce growth factors and inflammatory and immune competent cells that could influence anastomotic healing [19, 20, 21].…”

Section: Discussionmentioning

confidence: 99%

Improved Healing of Extraperitoneal Intestinal Anastomoses in the Early Phase when Surrounded by Omentum

et al. 2000

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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. Method: 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. Conclusion: The healing of intestinal anastomoses in an extraperitoneal position is improved in the early phase only when surrounded by omentum.

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“…The effect of a free peritoneal or pleural patch surrounding an intestinal anastomosis has been studied previously [8, 9, 10, 11, 12, 13]. In most studies a mesothelial patch had a favorable effect on the leakage rate [9, 12, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Grafting of free peritoneal flaps has been shown feasible both in animal experiments and in clinical situations [8, 9, 10, 11, 12, 13]. We hypothesized that the use of a free peritoneal patch surrounding the esophagogastrostomy in the neck might overcome the lack of mesothelial cells and might thus improve anastomotic healing, resulting in a decreased leakage rate and stricture formation.…”

Section: Introductionmentioning

confidence: 99%

A Free Peritoneal Patch Does Not Affect the Leakage Rate but Increases Stricture Formation of a Cervical Esophagogastrostomy

Oosterom¹,

Lanschot²,

Oosting

et al. 1999

Dig Surg

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Background: Healing of a cervical esophagogastrostomy is frequently impaired, resulting in a higher incidence of leakage and stricture formation, as compared to an intrathoracic anastomosis. Lack of mesothelial factors is hypothesized to contribute to this impaired anastomotic healing. The aim of this prospective study was to determine whether a free peritoneal patch around a cervical esophagogastrostomy can improve anastomotic healing. Methods: In 23 consecutive patients a free peritoneal patch was fixed around a cervical esophagogastrostomy. Results were compared to those of a historical control group of 41 patients. Clinical and/or radiographic leakage and stenosis requiring endoscopic dilatation were used as endpoints. Results: Three patients died in the early postoperative period (in-hospital mortality 3/64 = 5%). Leakage rate was 13% (3/23) in the group with a patch and 15% (6/41) in the control group (p = 0.90). At 6-month follow-up, the incidence of stenosis was significantly higher (65%) in the group with a patch, compared to 31% in the control group (p = 0.02). Conclusion: A peritoneal patch does not affect the leakage rate but increases the incidence of postoperative stenosis of a cervical esophagogastrostomy. Therefore, its clinical application is contraindicated.

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Comparative study of free omental, peritonenal, Dacron velour, and Marlex mesh reinforcement of large-bowel anstomosis

Cited by 24 publications

References 4 publications

Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

Improved Healing of Extraperitoneal Intestinal Anastomoses in the Early Phase when Surrounded by Omentum

A Free Peritoneal Patch Does Not Affect the Leakage Rate but Increases Stricture Formation of a Cervical Esophagogastrostomy

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