Reopening of the gastroduodenal pylorus after its closure in rats

Duodenal injury occurs in 3% to 12% of patients with abdominal trauma. The best procedure to treat major duodenal ruptures continues to be a challenge. The purpose of the present study was to analyze differences between the time of gastroduodenal pylorus reopening after its closure with different suture materials and to verify the influence of vagotomy on local tissue changes.

Thirty rats were submitted to closure of the gastroduodenal pylorus and gastrojejunal anastomosis. The animals were divided into three groups (n = 10) according to the type of suture material used: plain catgut, polyglycolic acid, and polypropylene. Half of the animals in each group (n = 5) were also submitted to truncal vagotomy. Postoperative assessment included weekly abdominal X-ray following intragastric contrast injection until re-establishment of the gastroduodenal transit or for a maximum period of 4 wk. At the end of the follow-up period, the pyloric regions and the gastrojejunal anastomosis were removed for histological analysis. The groups were compared by the Kaplan-Meier test, with the level of significance set at P < 0.05.

The polypropylene suture maintained the pylorus closed for a longer period of time (36.3 +/- 11.6 d) (P < 0.05). No difference was observed between the polyglycolic acid suture (25.8 +/- 14.2 d) and the plain catgut suture (18.7 +/- 10.2 d). Vagotomy did not influence the time of pyloric reopening, but was associated with a less intense gastric inflammatory reaction.

The nonabsorbable suture was the most adequate for exclusion of pyloric transit. Vagotomy had no influence on the time of pyloric reopening but reduced gastric inflammation.