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. 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.

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

“…Unfortunately, many of these attempts have failed to show convincing results [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]. Numerous studies have reported on the sealing of gastrointestinal anastomoses with fibrin glue (FG), also called fibrin sealant.…”

Clinical review: Healing in gastrointestinal anastomoses, Part II

“…Early healing of extraperitoneal anastomoses shows improved bursting pressures with omental wraps. 26 When applied to ''compromised'' anastomoses, or those that had been made ischemic intraoperatively, leak rates were improved with omentoplasty in a rat model. 27 However, a large, randomized control group of 705 patients showed no benefit with omentoplasty after colonic or rectal resection.…”

Reinforcement of Extraperitoneal Gastrointestinal Anastomoses by Omentum

“…We read with interest the article by Pierie and coworkers on omentoplasty reinforcement of extraperitoneal intestinal anastomoses in rats [1]. Esophagogastric anastomoses constructed in the neck are generally more likely to leak than esophagogastric anastomoses that are located in the pleural cavity.…”