Ex vivo comparison of leak testing of canine jejunal enterotomies: Saline infusion versus air insufflation. Issue 6 (13th May 2021) - Mullen, Kaitlyn M.
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.