Ex vivo comparison of leak testing of canine jejunal enterotomies: Saline infusion versus air insufflation.

Abstract

OBJECTIVE: To compare the ability to detect leakage of enterotomy closures by intraluminal injection of saline or air. STUDY DESIGN: Ex vivo study. ANIMALS: Grossly normal jejunal segments (n = 60) from five fresh canine cadavers. METHODS: Eight-centimeter jejunal segments were randomly assigned to two control (saline control [n = 5], air control [5]) and two treatment groups (injection of saline [n = 25] or air [25] after enterotomies were closed in a simple continuous pattern using 4-0 glycomer 631). Initial leak pressure (ILP, mean ± SD), maximum intraluminal pressure (MIP), and leakage location were compared. For all air insufflation constructs, the volume of air insufflated at the time of initial leakage was recorded. RESULTS: The ILPs of control segments did not differ whether injected with saline (405.71 ± 56.97 mmHg) or air (376.84 ± 42.54, p = 1.00). Enterotomy closures leaked at lower pressures when injected with air (ILP: 68.52 ± 6.56) compared to saline (87.76 ± 5.20, p = .03). Similar results were obtained when comparing MIPs. A moderate association (r = .51) was identified between volume of air infused and ILPs. The strength of the association improved when stratified by cadaver. The location of leakage-most commonly suture tracks-was identified for all air constructs and for 14 of 25 saline constructs. CONCLUSION: Enterotomy closures leaked at lower pressures after intraluminal injection of air compared to saline. CLINICAL SIGNIFICANCE: Intraoperative leak testing of small intestinal enterotomy closures may be rendered more sensitive and precise by the use of air instead of saline as the infusate.