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Published on: May 11, 2011
Influence of small intestinal serosal defect closure on leakage rate and adhesion formation: a pilot study using
Marcel Binnebösel1, Christian D Klink, Jochen Grommes
1Department of Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074, Aachen, Germany. mbinneboesel@ukaachen.de
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 mm(2). 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 mm(2). 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.
