OMENTAL PEDICLE GRAFT TO IMPROVE ISCHEMIC ANASTOMOSES

An end-to-end anastomosis was done in the center of a 5-cm devasculari zed jejunal segment in 5 control laboratory rabbits and 14 experimenta l rabbits. A second group consisted of 5 control animals and 11 experi mental animals having end-to-end jejunojejunostomy in the center of a 10-cm devascularized jejunal segment. In the experimental animals, the anastomosis was wrapped circumferentially by a vascularized omental p edicle. Anastomotic leaks or fistulas developed in five 10-cm controls (100%), five 5-cm controls (100%), nine 10-cm omental wraps (82%), an d four 5-cm omental wraps (29%). The remaining animals had strictures of various degrees. Injection of methylene blue into the omental vesse ls showed perfusion to the mucosa from the omentum. The difference bet ween the 10-cm segment and the 5-cm segment indicates some limitation to the available blood flow from the omentum. The anastomotic strictur ing was due to ischemic injury before reperfusion by ingrowth of oment al vessels. A vascularized omental pedicle wrap can augment blood flow ; however, the time required for neovascular ingrowth allows ischemic mucosal injury if there is no other available blood supply.