Comparison of different surgical repairs in the treatment of experimental duodenal injuries

Background: One of the most challenging management problems in clinical surgery is the injured duodenum. Although duodenal injuries are uncommon anda are found in 3-5% of all laparatomies for trauma. Approximately 80% of all duodenal injuries can be safely repaired with primary repair. 20% of all duodenal injuries are severe duodenal injuries and need complex surgical repair technics. In this experimantal study, we aimed to investigate the results of different surgical repair methods for delayed reconstruction of severe duodenal defects. Methods: A large duodenal defect with irregular and tagged margins covering about 50% of the circumference was created in the second part of duodenum. The rats each consisting of 7 rats were divided into 4 groups ( in group I ,sham operated, the duodenal defects were left without repair group; in group II was primary repairgroup ; in group III jejunal serosal patch group; in group IV porcine dermal collagen patch group). All rats sacrificed at postoperatif 21. day and the effectiveness of 4 technics were investıgated on the basis of survival ,histologic asessment and bursting pressure. Results: In terms of bursting pressure, no statistically significant difference between groups. Highest bursting pressure levels were measured in the repair group with porcine dermal collagen patch (mean burstin pressure: 295.67mmHg). There was no significant difference between groups in the development of fibrosis , ulcers and inflammation. Groups in terms of the extent of epithelialization and the presence of foreign bodies were found statistically significant differences when compared with each other. Conclusions: Porcine dermal collagen patch with complex repairs can be made with low mortality rates in duodenal injury. Highest bursting pressure levels were measured in the repair group with porcine dermal collagen patch. This may indicate that porcine dermal callagen patch can be used in the repair of experimental large duodenal defects safetly.