Impaired healing of extraperitoneal intestinal anastomoses

Background: The extra-anatomical position of a cervical oesophagogastrostom y might be a reason for impaired anastomotic healing. Methods: This hypothesis was tested in a rat model. Jejunal resection with an end-to-end jejunojejunostomy was placed intra-abdominally in group 1 (n = 24) and subcutaneously in group 2 (n = 30). Jejunum without anastomosis w as placed subcutaneously in group 3 (n = 12). After 3, 7 or 14 days the rat s were killed; the bursting pressure of the anastomosis or jejunum was meas ured and the hydroxyproline level was determined. Results: Two of 24 rats in group 1 and eight of 30 in group 2 died followin g anastomotic leakage (P not significant) and were excluded from other meas urements. Bursting pressure was decreased after 3 days in group 1 (mean(s.e .) 62(10) mmHg) and group 2 (57(10) mmHg) compared with that in group 3 (20 4(17) mmHg) (P < 0.001). After 7 days, it was in the normal range in group 1 (200(14) mmHg), but lower in group 2 (104(15) mmHg) compared with that in group 3 (230(8) mmHg) (P < 0.001), Differences in hydroxyproline levels we re not statistically significant between the groups after 3, 7 and 14 days. Conclusion: Healing of jejunojejunostomies is impaired in an extraperitonea l position compared with an intra-abdominal position.