Assessment of leakage pressure following enterotomy closure reinforced by tissue adhesive in a caprine cadaver model

Abstract

AIMS: To compare the combination of suture and tissue adhesive with suture alone for closure of enterotomy incisions in an ex vivo caprine jejunal model, by measuring the intraluminal pressure at which leakage occurred and the proportion of closures that leaked at intraluminal pressures <40 mmHg.

METHODS: Jejunal tissue was harvested from a goat following euthanasia, and enterotomy incisions (4 mm in length) were made in each of 24 isolated jejunal segments. The enterotomies were randomly assigned to be closed using a single interrupted suture alone (n=12) or in combination with biopolymer tissue adhesive (n=12). The jejunal segments were infused with saline containing fluorescent dye and leakage pressure was defined as the peak pressure attained when visible leakage of saline solution occurred. The number of enterotomies that did or did not exhibit leakage at <40 mmHg intraluminal pressure was also recorded.

RESULTS: Enterotomies closed using a combination of suture and tissue adhesive leaked at higher intraluminal pressure (58.2 (SD 4.7) mmHg) than those closed with suture alone (29.8 (SD 4.2) mmHg; p<0.001). The proportion of enterotomy closures in which the intraluminal pressure failed to reach 40 mmHg before leakage occurred was higher in enterotomies closed using suture alone (9/12, 75%) compared to those closed using both suture and tissue adhesive (3/12, 25%; p=0.002).

CONCLUSIONS AND CLINICAL RELEVANCE: Use of tissue adhesive in addition to sutures increased the intraluminal pressure achieved before leakage occurred, compared to sutures alone, following enterotomy closure in a caprine cadaver model. In vivo studies are indicated to further assess the value of supplementing intestinal suture lines with tissue adhesive.

KEY WORDS:

• Gastro-intestinal surgery
• tissue adhesive
• enterotomy
• leakage
• dehiscence
• small intestine
• ex vivo model