Improved Healing Of Extraperitoneal Intestinal Anastomoses In The Early Phase When Surrounded By Omentum

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 In = 29), subcutaneously surrounded by omentum in group II In = 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 15/29, 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. Copyright (C) 2000 S. Karger AG. Basel.