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Langenbeck's Archives of Surgery
Published in: Langenbeck's Archives of Surgery 1/2011

01-01-2011 | Original Article

Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models

Authors: Marcel Binnebösel, Christian D. Klink, Jochen Grommes, Marc Jansen, Ulf P. Neumann, Karsten Junge

Published in: Langenbeck's Archives of Surgery | Issue 1/2011

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Abstract

Background

The management of small intestinal serosal defects remains controversial. Non-closure of such defects is regarded as a risk factor of fistula formation or intestinal leakage, whereas defect closure with absorbable suture material is potentially associated with adhesion formation. The aim of our pilot study was to evaluate the influence of small intestinal serosal defect closure on peritoneal wound healing, leakage rate, and adhesion formation in a rabbit model.

Methods

Twenty-two male rabbits were randomized into two groups. Following median laparotomy, a standardized small intestinal serosal defect with a diameter of 1 cm was performed. Either the defect was closed by two seromuscular 4/0 polyglactin single sutures (n = 11) or the defect was left open (n = 11). On postoperative day 14, all animals were sacrificed for morphological investigations. Complications and the rate of intestinal leakage were measured. The degree of adhesion formation was measured by computer-assisted planimetry.

Results

No animal developed fistula formation or intestinal leakage. Eight (73%) animals of the closure group developed local peritoneal adhesions with a mean size of 39.7 ± 45 mm2. No animal in the non-closure group revealed local peritoneal adhesions at the defect. However, two (18%) animals in the non-closure group developed peritoneal adhesions distant to the defect with a mean size of 3.5 ± 9 mm2. Comparing both groups, the size of peritoneal adhesions was significantly higher in the closure group (p = 0.013).

Conclusions

Closure of isolated serosal injuries with resorbable suture material was associated with an adhesion formation in distressing certainty, whereas no leakage or fistula formation could be observed at all. Further studies are needed to clarify the impact of serosal defect closure in particular on leakage rate and fistula formation, e.g., with pre-existing adhesions, in case of multiple serosal injuries or with a pre-existing peritonitis.
Literature
1.
Tingstedt B, Isaksson J, Andersson R (2007) Long-term follow-up and cost analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions. Br J Surg 94(6):743–748CrossRefPubMed
2.
Tingstedt B, Andersson E, Isaksson K et al (2008) Clinical impact of abdominal adhesions: what is the magnitude of the problem? Scand J Gastroenterol 43(3):255–261CrossRefPubMed
3.
Kumar S, Wong PF, Leaper DJ. (2009) Intra-peritoneal prophylactic agents for preventing adhesions and adhesive intestinal obstruction after non-gynaecological abdominal surgery. Cochrane Database Syst Rev (1):CD005080
4.
Rajab TK, Wallwiener M, Talukdar S et al (2009) Adhesion-related complications are common, but rarely discussed in preoperative consent: a multicenter study. World J Surg 33(4):748–750CrossRefPubMed
5.
Sulaiman H, Gabella G, Davis MS et al (2001) Presence and distribution of sensory nerve fibers in human peritoneal adhesions. Ann Surg 234(2):256–261CrossRefPubMed
6.
Sulaiman H, Gabella G, Davis C et al (2000) Growth of nerve fibres into murine peritoneal adhesions. J Pathol 192(3):396–403CrossRefPubMed
7.
diZerega GS (1997) Biochemical events in peritoneal tissue repair. Eur J Surg Suppl (577):10–16
8.
Committee of American Society for Reproductive Medicine in collaboration with Society of Reproductive Surgeons (2007) Pathogenesis, consequences, and control of peritoneal adhesions in gynecologic surgery. Fertil Steril 88(1):21–26CrossRef
9.
Aydin C, Aytekin FO, Yenisey C et al (2008) The effect of different temporary abdominal closure techniques on fascial wound healing and postoperative adhesions in experimental secondary peritonitis. Langenbecks Arch Surg 393(1):67–73CrossRefPubMed
10.
Duron JJ (2007) Postoperative intraperitoneal adhesion pathophysiology. Colorectal Dis 9(Suppl 2):14–24CrossRefPubMed
11.
Hubbard TB Jr, Khan MZ, Carag VR Jr et al (1967) The pathology of peritoneal repair: its relation to the formation of adhesions. Ann Surg 165(6):908–916CrossRefPubMed
12.
Rosch R, Junge K, Binnebosel M et al (2008) Gas-related impact of pneumoperitoneum on systemic wound healing. Langenbecks Arch Surg 393(1):75–80CrossRefPubMed
13.
Uludag M, Citgez B, Ozkaya O et al (2010) Effects of the amniotic membrane on healing of colonic anastomoses in experimental left-sided colonic obstruction. Langenbecks Arch Surg 395(5):535–543CrossRefPubMed
14.
Campion JP, Nomikos J, Launois B (1988) Duodenal closure and esophagojejunostomy experience with mechanical stapling devices in total gastrectomy for cancer. Arch Surg 123(8):979–983PubMed
15.
Karabulut B, Sonmez K, Turkyilmaz Z et al (2006) Omentum prevents intestinal adhesions to mesh graft in abdominal infections and serosal defects. Surg Endosc 20:978–982CrossRefPubMed
16.
Conze J, Junge K, Klinge U et al (2005) Intraabdominal adhesion formation of polypropylene mesh. Influence of coverage of omentum and polyglactin. Surg Endosc 19(6):798–803CrossRefPubMed
17.
Angele MK, Chaudry IH (2005) Surgical trauma and immunosuppression: pathophysiology and potential immunomodulatory approaches. Langenbecks Arch Surg 390(4):333–341CrossRefPubMed
18.
Flohe S, Flohe SB, Schade FU et al (2007) Immune response of severely injured patients—influence of surgical intervention and therapeutic impact. Langenbecks Arch Surg 392(5):639–648CrossRefPubMed
19.
Matsukuma S, Goda K, Sakai Y et al (1999) Histopathologic studies of colorectal postendoscopic resection sites: "skipping electrothermal injury" associated with endoscopic resection procedures. Am J Surg Pathol 23(4):459–464CrossRefPubMed
20.
Aarons CB, Cohen PA, Gower A et al (2007) Statins (HMG-CoA reductase inhibitors) decrease postoperative adhesions by increasing peritoneal fibrinolytic activity. Ann Surg 245(2):176–184CrossRefPubMed
21.
Tang CL, Jayne DG, Seow-Choen F et al (2006) A randomized controlled trial of 0.5% ferric hyaluronate gel (Intergel) in the prevention of adhesions following abdominal surgery. Ann Surg 243(4):449–455CrossRefPubMed
22.
Zeng Q, Yu Z, You J et al (2007) Efficacy and safety of Seprafilm for preventing postoperative abdominal adhesion: systematic review and meta-analysis. World J Surg 31(11):2125–2131CrossRefPubMed
23.
Luijendijk RW, de L, Wauters CC et al (1996) Foreign material in postoperative adhesions. Ann Surg 223(3):242–248CrossRefPubMed
24.
Sturdy JH, Baird RM, Gerein AN (1967) Surgical sponges: a cause of granuloma and adhesion formation. Ann Surg 165(1):128–134CrossRefPubMed
25.
Whitfield RR, Stills HF Jr, Huls HR et al (2007) Effects of peritoneal closure and suture material on adhesion formation in a rabbit model. Am J Obstet Gynecol 197(6):644–645CrossRefPubMed
26.
Bakkum EA, Dalmeijer RA, Verdel MJ et al (1995) Quantitative analysis of the inflammatory reaction surrounding sutures commonly used in operative procedures and the relation to postsurgical adhesion formation. Biomaterials 16(17):1283–1289CrossRefPubMed
27.
O'Leary DP, Coakley JB (1992) The influence of suturing and sepsis on the development of postoperative peritoneal adhesions. Ann R Coll Surg Engl 74(2):134–137PubMed
28.
Binnebosel M, Rosch R, Junge K et al (2008) Macrophage and T-lymphocyte infiltrates in human peritoneal adhesions indicate a chronic inflammatory disease. World J Surg 32(2):296–304CrossRefPubMed
29.
Binnebosel M, Klinge U, Rosch R et al (2008) Morphology, quality, and composition in mature human peritoneal adhesions. Langenbecks Arch Surg 393(1):59–66CrossRefPubMed
30.
Hoshino A, Kawamura YI, Yasuhara M et al (2007) Inhibition of CCL1–CCR8 interaction prevents aggregation of macrophages and development of peritoneal adhesions. J Immunol 178(8):5296–5304PubMed
31.
Stumpf M, Junge K, Rosch R et al (2009) Suture-free small bowel anastomoses using collagen fleece covered with fibrin glue in pigs. J Invest Surg 22(2):138–147CrossRefPubMed
32.
Jonsson T, Hogstrom H (1992) Effect of suture technique on early healing of intestinal anastomoses in rats. Eur J Surg 158(5):267–270PubMed
33.
Jonsson T, Hogstrom H (1991) Diathermy-induced inflammation does not affect suture holding capacity of intestinal anastomoses. Eur Surg Res 23(3-4):235–239CrossRefPubMed
34.
Jonsson T, Hogstrom H, Zederfeldt B (1993) Effect of interrupted and continuous suturing on intestinal wound margin strength in rats. Eur Surg Res 25(3):169–173CrossRefPubMed
Metadata
Title
Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using rabbit models
Authors
Marcel Binnebösel
Christian D. Klink
Jochen Grommes
Marc Jansen
Ulf P. Neumann
Karsten Junge
Publication date
01-01-2011
Publisher
Springer-Verlag
Published in
Langenbeck's Archives of Surgery / Issue 1/2011
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI
https://doi.org/10.1007/s00423-010-0672-8

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