J.Jpn. Surg. Soc.. 81(3): 264-280, 1980
Original article
USE OF FREE PERITONEAL PATCH IN REENFORCING ALIMENTARY TRACT ANASTOMOSIS AND WOUND HEALING IN ISCHEMIC INTESTINAL ANASTOMOSIS
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2nd Department of Surgery, Kyushu University, Faculty of Medicine, Fukuoka, Japan (Director: Prof. Kiyoshi Inokuchi) Akira Yaita |
1. Five of ten dogs died from leakage in one-layer everting anastomosis but no leakage occurred when the peritoneal patches were added. At sacrifice adhesion at the anastomotic site was found thicker in those with peritoneal patch with “smooth side in” than in those with “smooth side out”.
The bursting pressure was higher, 220±42.9mmHg in the “smooth side out” than in the “smooth side in”, 143±75.7mmHg (p＜0.05). Therefore, the application of the peritoneal patch with “smooth side out” was superior to that with “smooth side in”.
2. The usefullness of free peritoneal patches was also demonstrated in the treatment of the already established fistula of the cervical esophagus and the duodenum.
3. In the intestine, ischemia reduced the blood flow of the mucosal layer more remarkably than the seromuscular layer. In ischemic intestinal anastomosis two-layer anastomosis method with seromuscular sutures had less leakage than the one-layer anastomosis. Histological findings showed that the mucosal layer was more affected by ischemia than the seromuscular layer and vascular communication around the anastomotic site in ischemic intestine was found to be formed more through the seromuscular layer than the mucosal layer.
4. Free peritoneal patch had reenforcing effect on ischemic intestinal anastomosis, particularly when applied to one-layer anastomosis.
5. Seroserosal adhesion was not affected by ischemia of the intestine, while remarkably reduced by steroid administration or hypoproteinemia.
These studies indicate that free peritoneal patch has reenforcing effet on the anastomosis with inadequate sero-serosal apposition and seromuscular suture is much important in ischemic condition.
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