Ex vivo comparison of leak testing of canine jejunal enterotomies: Saline infusion versus air insufflation

Abstract

Objective: To compare the ability to detect leakage of enterotomy closures by intraluminal injection of saline or air.Study Design: Ex vivo study. Animals: Grossly normal jejunal segments (n = 60) from five fresh canine cadavers. Methods: Eight-centimeter jejunal segments were randomly assigned to two control (saline control [n = 5], air control [5]) and two treatment groups (injection of saline [n = 25] or air [25] after enterotomies were closed in a simple continuous pattern using 4-0 glycomer 631). Initial leak pressure (ILP, mean ± SD), maximum intraluminal pressure (MIP), and leakage location were compared. For all air insufflation constructs, the volume of air insufflated at the time of initial leakage was recorded.Results: The ILPs of control segments did not differ whether injected with saline (405.71 ± 56.97 mmHg) or air (376.84 ± 42.54, p = 1.00). Enterotomy closures leaked at lower pressures when injected with air (ILP: 68.52 ± 6.56) compared to saline (87.76 ± 5.20, p = .03). Similar results were obtained when comparing MIPs. A moderate association (r = .51) was identified between volume of air infused and ILPs. The strength of the association improved when stratified by cadaver. The location of leakage-most commonly suture tracks-was identified for all air constructs and for 14 of 25 saline constructs. Conclusion: Enterotomy closures leaked at lower pressures after intraluminal injection of air compared to saline. Clinical Significance: Intraoperative leak testing of small intestinal enterotomy closures may be rendered more sensitive and precise by the use of air instead of saline as the infusate.

Ex vivo and in vivo evaluation of a modified interrupted Lembert pattern for small intestinal anastomoses in horses

“…A major limitation of ex vivo studies is relevance of findings to live tissue, 24 as demonstrated by increased anastomotic index ex vivo versus in vivo for the mod‐IL (Figure 5). This difference could be attributed to greater tone and thickness in the live muscle layers that might have resisted expansion from stay sutures, or changes to regional blood flow and inflammation from handling.…”

“…Two control segments and two of each anastomosis were collected for duplicate BP recordings from each horse. The anastomoses were completed by ESC, rinsed with water, placed in a refrigerator (4°C), and then each was selected randomly for testing in a plastic tub filled with water 2,23,24 . One jejunal end was ligated with ¼‐inch umbilical tape.…”

“…A 20‐gauge 2‐inch polyurethane catheter (Terumo Medical Corporation, Somerset, NJ, USA) was inserted through the intestinal wall after it reached a moderate degree of distention. Rigid pressure tubing connected this catheter to a pressure transducer, transducer amplifier, and pressure monitoring system (AD Instruments, Sydney, Australia) 23,24 . The system was purged of air and the transducer was placed level with the estimated midpoint of the intestinal segment in the water tub.…”

“…The system was purged of air and the transducer was placed level with the estimated midpoint of the intestinal segment in the water tub. The system was calibrated with a pressure monitoring system and a sphygmomanometer (Welch Allyn, Skaneateles Falls, New York) 24 . This equipment continuously displayed intraluminal pressures over time to specimen failure, 3,23 evident as dye leakage (Figures 2 and 3).…”

Influence of crotch suture augmentation on leakage pressure and leakage location during functional end‐to‐end stapled anastomoses in dogs

“…Supplemental techniques shown to increase ILP such as wrapping the FEESA in omentum, serosal patch supplementation, use of surgical sealants or buttressing materials were not evaluated. 21,32 Intraoperatively, leak testing is routinely performed following FEESA using saline 7,16 or air 36 to detect gaps along the anastomotic line where supplemental sutures may be added at the discretion of the primary surgeon. This was not performed, however, which may have led to additional sutures being placed thus affecting ILP and MLP or sites of observed leakage.…”