Relative Mechanical Strength of Jejuno-Jejunostomies Performed With and Without Intestinal Clamps.

Abstract

The experiments reported in this communication were undertaken in an attempt to elucidate the rôle played by clamps in post-operative recovery from entero-enterostomies, especially with respect to the comparative mechanical strength of wounds made according to a “clamp” or a “clampless” technique. Twenty-nine dogs were used as experimental animals, of which 26 appear in the final report, one having died on the 2nd post-operative day of general peritonitis, and 2 others, though apparently recovering normally when killed and autopsied on the 4th post-operative day, having shown the presence of a small amount of pus in connection with their enterostomy wounds.

Two enterostomies, one with clamps and the other without clamps, were performed in each animal on the same day, the operative procedures consuming a period from November 9, 1927, to March 29, 1928. Enterostomies were performed in the upper jejunum some 10 inches apart and from 12 to 18 inches from the pylorus. The first enterostomy was performed with clamps in the first 13 animals and the second enterostomy in the second 13 animals; the other enterostomy in each animal was performed with the aid of “guy sutures”.

The animals were killed at intervals of one day in such a manner that each post-operative day, up to and including the 12th day, was represented by 2 animals; this was done in a hit or miss manner, however, in such a way as to bring some of the animals appearing early in the operative series late in the autopsy series, and vice versa.

Four segments of intestine, each about 4 inches in length, were cut from the jejunum of each animal at autopsy, the first being cut from the normal gut just proximal to the first entero-enterostomy, the 2nd including the first enterostomy, the 3rd including the 2nd entero-enterostomy, and the 4th being a segment cut just distal to the 2nd enterostomy. The bursting pressure of these segments was measured by forcing air into them and recording, by means of an attached mercury manometer, the pressure at which they burst.