[Dumping syndrome].

This study examines the utility of a sleeve anastomosis with comparison to conventional end to end anastomosis. Thirty New Zealand white rabbits were randomized to sleeve (n = 15) or end-to-end (n = 15) small bowel anastomosis. Five rabbits of each group were sacrificed at 3 days, 7 days, and 6 weeks. Anastomoses were assessed for integrity, bursting strength, and stenosis and examined histologically. Ten control specimens of small bowel were tested for bursting pressure. Three rabbits died postoperatively (1 sleeve and 2 end-to-end). A fourth rabbit (sleeve) was sacrificed early at 3 weeks and had a total stenosis at the anastomosis. The remaining 26 rabbits were reoperated at the prescribed times. There was no evidence of infection or dehiscence in any of these rabbits. Both end-to-end and sleeve anastomoses were equivalent for bursting pressure at all times and, at 7 days and 6 weeks, were similar to controls. The stenotic index revealed no evidence of proximal dilation suggestive of obstruction in the 26 rabbits. For sleeve anastomoses the length of the projected bowel into the lumen persisted at the 6-week stage. Histologically there was good evidence of healing in both the sleeve and end-to-end anstomoses and the serosal surface of the sleeved bowel had epithelialized. Sleeve anastomosis has been demonstrated to heal well and to be as strong as conventional end-to-end anastomosis. Further studies are warranted to determine its role in intestinal anastomosis and potential as a valve.

Anastomosis, Surgical↗

PubMed1999

Effects of omental wrap on performance of small-caliber high-porosity expanded polytetrafluoroethylene grafts.

The purpose of this study was to evaluate the effects of omental wrap on the performance of small-caliber expanded polytetrafluoroethylene (ePTFE) grafts, with a special reference to transmural capillary ingrowth. High-porosity ePTFE grafts with a fibril length of 60 micrometer, an internal diameter of 4 mm, and 40 mm in length were implanted into the canine bilateral carotid arteries. The grafts on the right side were wrapped in an omental pedicle flap (omentum-wrap grafts), while those on the left were not (nonwrap grafts). The grafts were retrieved at intervals of 4 and 12 weeks. At 4 weeks, the patency rates of the omentum-wrap grafts and nonwrap grafts were almost the same (5/6 vs 6/6). At 12 weeks, patency tended to be higher in the omentum-wrap grafts than in the nonwrap grafts (3/5 vs 1/5). At 4 weeks, the thrombus-free surface score (TFS) was significantly higher in the omentum-wrap grafts than in the nonwrap grafts (44.8% vs 30.2%, P < 0.05). At 12 weeks, the TFS tended to be higher in the omentum-wrap grafts than in the nonwrap grafts (84.6% vs 62.4%). At 4 weeks, both the capillary transsectional area score (CTS) and capillary density were significantly higher in the omentum-wrap grafts than in the nonwrap grafts (CTS, 3.3% vs 1.1%, P < 0.05; capillary density, 196.0/mm2 vs 83.3/mm2, P < 0.05). At 12 weeks, both CTS and capillary density tended to be higher in the omentum-wrap grafts than in the nonwrap grafts (CTS, 1.1% vs 0%; capillary density, 69.4/mm2 vs 0/mm2). At 4 weeks, in the omentum-wrap grafts, extracellular matrices and cells in the interstices of the graft were stained with an antibody against VEGF. In conclusion, the omental wrap enhances transmural capillary ingrowth and thereby promotes endothelialization in small-caliber high-porosity ePTFE grafts. VEGF appears to play an active role in transmural capillary ingrowth enhanced by omental wrap.

Anastomosis, Surgical↗