THE PROTECTIVE ROLE OF PEDICLED OMENTAL GRAFT ON UNSAFE SMALL INTESTINAL ANASTOMOSIS: AN EXPERIMENTAL STUDY WITH HISTOLOGICAL EVALUATION IN DOGS | ||||
| The Egyptian Journal of Surgery | ||||
| Volume 22, Issue 4, October 2003, Page 343-352 PDF (753.07 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/ejsur.2003.374247 | ||||
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| Authors | ||||
| Ayman A. Talaat* 1; Hisham H. Wagdy1; Samy Saad Mohamed Aly1; Faika Hassan El-Ebiary2 | ||||
| 1Departments of General Surgery, Faculty of Medicine, Ain Shams University | ||||
| 2Histology, Faculty of Medicine, Ain Shams University | ||||
| Abstract | ||||
| Background: The pedicled omental graft has wide uses in surgery. Some authors have described its clinical use for protection of gastrointestinal anastomoses, particularly after rectal and oesophageal anastomoses. It was found that the rate of anastomotic leakage after small bowel anastomoses in generalized peritonitis is high. After resection of a necrotic intestinal segment, there will be a low blood flow at the anastomosis due to collateral circulation and the healing may therefore be impaired. In these conditions the anastomosis of the bowel is unsafe and a defective anastomosis usually results. Aim: This work is an experimental study on dogs to test the ability of the pedicled omental graft to protect the mechanically impaired (interrupted) small intestinal anastomosis with partially ischaemic edges i.e. unsafe. The possibility for induction of anastomotic healing was also investigated. Material and Methods: Fifteen male dogs were randomly divided into three groups. Group (I) composed of three dogs were used as control (sham operated control group); group (II) composed of 3 dogs with mechanically impaired unsafe anastomosis without omental wrap, group (III) composed of 9 dogs with mechanically impaired unsafe anastomosis covered with omental wrap. The animals were housed in Medical Research Center, Faculty of Medicine, Ain Shams University. All animals of group (I) and only 7 dogs of group (III) were sacrificed after 6 weeks and the anastomoses together with the omental wrappings were histologically examined. One of the remaining two dogs of group (III) was sacrificed after 3 days and the other dog was scarified after 7 days to examine the gross appearance of the sites of the anastomoses to determine the progress of healing.. Results: All the animals of group (II) died within 2-5 days after the operation. Autopsy revealed frank peritonitis with intestinal leakage. All the experimental animals of group (I) and (III) survived till the end of the experiment. All the anastomoses of group III dogs appeared to be in good condition by naked eye and no leakage was observed. The blood supply of the omentum in all animals was good. The most significant histological results were the restoration of the mucosal continuity and the increase collagen content at the gaps in-between the sutures of all anatomoses of animals of group (III). Heavy mononuclear cellular infiltration was also observed in- between the muscle fibers of musculris externa as well as in the omental wrap of the anastomoses. Conclusion: Covering of an impaired unsafe intestinal anastomosis with a pedicled omental graft can secure the anastomosis and give it some strength. Subsequently the incidence of leakage and peritonitis is reduced thereby, ensuring the survival of the experimental animals. | ||||
| Keywords | ||||
| Pedicled omental graft; Unsafe small intestinal anatomosis; Omental wrap | ||||
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