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THE PROTECTIVE ROLE OF PEDICLED OMENTAL GRAFT ON UNSAFE SMALL INTESTINAL ANASTOMOSIS: AN EXPERIMENTAL STUDY WITH HISTOLOGICAL EVALUATION IN DOGS

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Last updated: 29 Dec 2024

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Abstract

Background: The pedicled omental graft has wide uses in surgery. Some authors have described its clinical use for 
protection of gastrointestinal anastomoses, particularly after rectal and oesophageal anastomoses. It was found that the rate of anastomotic leakage after small bowel anastomoses in generalized peritonitis is high. After resection of a necrotic 
intestinal segment, there will be a low blood flow at the anastomosis due to collateral circulation and the healing may 
therefore be impaired. In these conditions the anastomosis of the bowel is unsafe and a defective anastomosis usually results. 
Aim: This work is an experimental study on dogs to test the ability of the pedicled omental graft to protect the mechanically impaired (interrupted) small intestinal anastomosis with partially ischaemic edges i.e. unsafe. The possibility for induction of anastomotic healing was also investigated. 
Material and Methods: Fifteen male dogs were randomly divided into three groups. Group (I) composed of three dogs were used as control (sham operated control group); group (II) composed of 3 dogs with mechanically impaired unsafe anastomosis without omental wrap, group (III) composed of 9 dogs with mechanically impaired unsafe anastomosis covered with omental wrap. The animals were housed in Medical Research Center, Faculty of Medicine, Ain Shams University. All animals of group (I) and only 7 dogs of group (III) were sacrificed after 6 weeks and the anastomoses together with the omental wrappings were histologically examined. One of the remaining two dogs of group (III) was sacrificed after 3 days and the other dog was scarified after 7 days to examine the gross appearance of the sites of the anastomoses to determine the progress of healing.. 
Results: All the animals of group (II) died within 2-5 days after the operation. Autopsy revealed frank peritonitis with 
intestinal leakage. All the experimental animals of group (I) and (III) survived till the end of the experiment. All the 
anastomoses of group III dogs appeared to be in good condition by naked eye and no leakage was observed. The blood supply of the omentum in all animals was good. The most significant histological results were the restoration of the mucosal continuity and the increase collagen content at the gaps in-between the sutures of all anatomoses of animals of group (III). 
Heavy mononuclear cellular infiltration was also observed in- between the muscle fibers of musculris externa as well as in the omental wrap of the anastomoses. 
Conclusion: Covering of an impaired unsafe intestinal anastomosis with a pedicled omental graft can secure the anastomosis and give it some strength. Subsequently the incidence of leakage and peritonitis is reduced thereby, ensuring the survival of the experimental animals.

DOI

10.21608/ejsur.2003.374247

Keywords

Pedicled omental graft, Unsafe small intestinal anatomosis, Omental wrap

Authors

First Name

Ayman

Last Name

A. Talaat

MiddleName

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Affiliation

Departments of General Surgery, Faculty of Medicine, Ain Shams University

Email

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City

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Orcid

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First Name

Hisham

Last Name

H. Wagdy

MiddleName

-

Affiliation

Departments of General Surgery, Faculty of Medicine, Ain Shams University

Email

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City

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Orcid

-

First Name

Samy

Last Name

Saad Mohamed Aly

MiddleName

-

Affiliation

Departments of General Surgery, Faculty of Medicine, Ain Shams University

Email

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City

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Orcid

-

First Name

Faika

Last Name

Hassan El-Ebiary

MiddleName

-

Affiliation

Histology, Faculty of Medicine, Ain Shams University

Email

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City

-

Orcid

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Volume

22

Article Issue

4

Related Issue

49818

Issue Date

2003-10-01

Receive Date

2024-08-15

Publish Date

2003-10-01

Page Start

343

Page End

352

Print ISSN

1110-1121

Online ISSN

1687-7624

Link

https://ejsur.journals.ekb.eg/article_374247.html

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https://ejsur.journals.ekb.eg/service?article_code=374247

Order

374,247

Type

Original Article

Type Code

3,086

Publication Type

Journal

Publication Title

The Egyptian Journal of Surgery

Publication Link

https://ejsur.journals.ekb.eg/

MainTitle

THE PROTECTIVE ROLE OF PEDICLED OMENTAL GRAFT ON UNSAFE SMALL INTESTINAL ANASTOMOSIS: AN EXPERIMENTAL STUDY WITH HISTOLOGICAL EVALUATION IN DOGS

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Article

Created At

21 Dec 2024