Enterectomy is a common procedure with 3%–28% incidence of intestinal leakage. Supplemental techniques to decrease leakage risk were described, but objective supporting evidence was limited. One technique is serosal patching, or placement of a healthy segment of intestine in direct serosal-to-serosal contact, effectively creating full-thickness intestinal coverage.
Leakage and maximum intraluminal pressures of intestinal anastomoses with and without serosal patch supplementation were compared in healthy small intestinal segments from 2 euthanized dogs. Intestines were sectioned to create 6 controls, 6 enterectomies with anastomoses alone, and 6 with anastomoses plus serosal patches. The patch was created by placing a single section of intestine perpendicular to the anastomosis, providing protection to 60%–70% of the anastomotic circumference.
An infusion catheter system with a microtip pressure transducer was used to measure the pressure at which leakage was first detected and the points of catastrophic failure, pressure plateau, or maximum pressure of the sensor. Mean leakage pressure was significantly higher for the segments with the serosal patches than for those with anastomoses alone. Maximum intraluminal pressures did not differ significantly. These findings, although performed on cadaveric tissues that may behave differently than live tissue, provide evidence that serosal patching could protect against postsurgical intestinal leakage and its associated complications.
After intestinal surgery, intestinal leakage or dehiscence is the most common and serious complication associated with high morbidity and mortality. Intestinal serosal patch technique can provide support and extra sealing of intestinal incisions at risk for leakage or dehiscence. Further evidence was offered concerning the mechanism of patching of intestinal anastomoses in canine cadavers within the first 24 hours of surgery and revealed that intestinal anastomoses reinforced by serosal patch may withstand significantly higher pressures than nonreinforced anastomoses. Intestinal anastomoses at risk for leakage or dehiscence may benefit from serosal patch reinforcement.—Lysimachos G. Papazoglou, DVM, PhD, MRCVS
Evaluation of serosal patch supplementation of surgical anastomoses in intestinal segments from canine cadavers. Hansen LA, Monnet EL. AM J VET RES 74:1138-1141, 2013.
This capsule is part of the WSAVA Global Edition of Clinician's Brief.