Comparison of ePTFE graft repair with primary suturing in an experimental duodenal perforation model in rats

BACKGROUND
In this experimental study, we treated peptic ulcer perforation in the first portion of the duodenum using an ePTFE (expanded polytetrafluoroethylene) soft tissue graft and compared results with primary suturing.
METHODS
Wistar Albino rats were randomized into two groups. A duodenal defect of 3 mm was created in the first portion of the duodenum in all 24 rats. Macroscopic evaluation was done to determine presence of intraabdominal leakage, peritonitis, intraabdominal adhesions, and the level of adhesion, if present. The adhesion severity scoring system was used to score severity of adhesions. Histology section score criteria were used for scoring in microscopic evaluation.
RESULTS
There was no statistically significant difference between the two groups in the adhesion severity scoring according to grades. However, when overall scoring was considered, a statistically significant difference was determined between the two groups (p=0.045). According to microscopic examination, there was no statistically significant difference between the two groups when classified into none to minimal cell accumulation, thin immature granulations and moderately thick granulation (p=0.089, p=0.178, p=0.755); however, there was a statistically significant difference between the two groups in the thick vascular granulation class (p=0.005).
CONCLUSION
Use of the ePTFE graft method is easy, and results are comparable to those achieved with primary suturing. However, our results need further confirmation with larger series in animals and also with human studies.

Sýçanlarda deneysel duodenal perforasyon modelinde ePTFE greft ile primer dikiþin karþýlaþtýrýlmasý

AMAÇ
Bu deneysel çalýþmada, duedenum birinci kýsýmda oluþturulan peptik ülser perforasyonu tedavisinde “expanded polytetrafluoroethylene” (ePTFE) greft ile primer dikiþ yöntemleri makroskopik ve mikroskopik olarak karþýlaþtýrýldý.
GEREÇ VE YÖNTEM
Wistar Albino sýçanlar rastgele her grupta 12’þer tane olacak þekilde iki gruba ayrýldý. Tüm deneklerde duedenum birinci kýsým ön yüzünde 3 mm çapýnda, tüm duedenum çapýnýn %50’sini geçmeyecek þekilde duodenal perforasyon oluþturuldu. Makroskopik olarak batýn içi kaçak, peritonit varlýðý ve karýn içi adezyonlar deðerlendirildi. Adezyonun þiddetini deðerlendirmek için adezyon þiddeti skorlama sistemi kullanýldý. Histolojik preparat skorlama ölçütleri mikroskopik deðerlendirme için kullanýldý.
BULGULAR
Her iki grubun adezyon þiddeti skorlamasýnýn istatistiksel analizinde anlamlý fark saptanmadý. Ancak, gruplar bir bütün olarak deðerlendirildiðinde adezyon siddeti skorlamasý anlamlýydý (p=0,045). Mikroskopik deðerlendirmenin istatistiksel analizinde “none to minimal cell accumulation, thin immatür granulation, moderately thick granulation” olarak sýnýflandýrýlan gruplarda primer dikiþ ve ePTFE arasýnda anlamlý fark bulunmadý (p=0,089, p=0,178, p=0,755). Ancak, “thick vascular granulation” olarak sýnýflandýrýlan grupta anlamlý fark bulundu (p=0,005).
SONUÇ
ePTFE greft uygulanmasý kolay, güvenilir ve sonuçlarý primer dikiþe benzer bir tekniktir. Ancak, bizim çalýþmamýzdaki sonuçlarýn daha büyük deneysel serilerde ve insan çalýþmalarýyla desteklenmesi gerekmektedir.