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International Journal of Animal and Veterinary Advance 2(3): 72-75, 2010
ISSN: 2041-2908
© M axwell Scientific Organization, 2010
Submitted Date: April 19, 2010 Accepted Date: May 01, 2010 Published Date: July 05, 2010
Small Bowel Wall Response to Enterotomy Closure with Polypropylene and

Polyglactin 910 Using Simple Interrupted Suture Pattern in Rats
O.D . Eyarefe and S .A. A mid

Departm ent of Veterinary Surgery and R eproduction, U niversity of Ibadan, N igeria
Abstract: Effects of polypropylene and polyglactin 910 on enterotomy wound healing were investigated.
Sixteen adult W istar albino rats (155.44±30.4 g) w ere random ized into two study groups, A with polypropylene
(n = 8) and B with polyglactin 910 (n = 8) following 1 cm mid-jejunal enterotomy incisions performed under
ketamine/xylazine anaesthesia. Body weights changes were evaluated daily for eleven days and two rats from
each group w ere euthanized at postoperative days 3, 5, 7 and 11. Following euthanasia, the enterotomy sites
were examined for dehiscence an d adhesion. Eviden ce of inflamm atory reactions and fibroblast proliferation
were also evaluated and scored. Lea ks from en terotomy site w ere not observed. Adhesion scores in-group A
(3.5) was statistically significant (p<0.05) when compared with group B (1.875). A non-statistically significant
(p>0.05) but higher fibroblasts count was recorded in Group A (2.625 ) compa red with group B (1.375).
Inflammatory responses in both groups w ere no t statistically significant, although that of Group B was higher
in response than group A. Enterotomy closure with polypropylene produced significant adhesion that may be
linked with the texture of the suture, and the several knots characteristic of the simple interrupted suture pattern.
Key w ords: Closure, enterotomy, interrupted pattern, polyglactin 910, polypropylene
INTRODUCTION there is a dearth of empirical verification in literature on

its efficacy for enterotomy closure. This study aimed at
There is a growing concern over the most suitable examining intestinal tissue responses to the polypropylene
material for the closure of surgical wounds that will and Polyglactin 910 follow ing en terotom y closure w ith
enhance rapid healing with minimal postoperative simple interrupted pattern in rats.
complications. This concern is of prime impo rtance in
enterotomy closure with its fatal consequences of MATERIALS AND METHODS
adhesion, stricture, lea ks, peritonitis, sho ck an d dea th
(Allen et al., 1992; Ralphs et al., 2003. Enterotomies are Experimental animals: This study was conducted at the
close conventionally in a single layer of natural or Department of Veterinary Surgery and Reproduction,
synthetic absorbable sutures, with interrupted or University of Ibadan, Nigeria, between February and
continuous suture patterns (Baines, 2000 a). How ever, October 2009. The Faculty ethical committee for usage of
closure with non-absorbable sutures has been animal approve d Sixteen (16 ) adult W istar albino ra ts
recom men ded (Bain es, 2000a). with mean body weight of 155.44±30.4 g for use
The need for an ideal suture material, especially for following assessment of study design for experimental
the closures of enterotomies, remains the focus of purposes. They were obtained from the Faculty of
research, because some of the absorbable suture materials Veterinary Me dicine, Un iversity of Ibadan, labo ratory
weaken over time as they are destroyed by hydrolytic and animal unit, housed in we ll ventilated cag e com partm ents
lysosomal enzymic activities before the wound gains with ample space for exercise, and provided w ith
adeq uate strength; resulting in leaks, peritonitis, and dea th comm ercial feed (Guinea feeds® ) and water ad libitum.
(Allen et al., 1992; Ralphs et al., 2003). In this study, we The rats were healthy based on clinical examination
compared the intestinal tissue responses to Polyglactin before com men cem ent of the exp eriment.
910 (Vicry l® Ethico n), a braided mu ltifilament synthetic
abso rbable suture material that has been recommended for Surgical procedure/experimental design: Following
both renal and gastrointestinal surgeries B aines, (2000a), aseptic preparation, and anaesthesia with intramuscular
with Polypropylene (Prolene® Ethicon), a synthetic non- injection of 2% (1 mg/100 gm) Xylazine (Kepro, Holland)
absorbable, less thrombo genic, and relatively inert suture. and 5% (9 mg/100 gm) Ketamine Hydrochloride (Rotex
Although polypropylene has been suggested for M edica, Germany), the small intestine was approached
intestinal surgery (Fossum et al., 2002; Baines, 2000a), via a ventral midline laparotomy. The jejunum was
Corresponding Author: O.D. Eyarefe, Department of Veterinary Surgery and Reproduction, University of Ibadan, Nigeria
72
Int. J. Anim. Veter. Adv., 2(3): 72-75, 2010
located, exteriorized, and a 1.0 cm enterotomy was made

with a size 10 scalpel blade as described by
(Baines, 2000b) and closed with five stitches, either w ith
polypropylene (Group A) or with Polyglactin (910)
(Group B) using simple interrupted suture pattern. The
laparotomy incision was closed as earlier described
(Eyarefe, 2008), and the rats were kept in warm recovery
cages. All the rats recovered smoothly from anaesthesia
and the m ortality rate zero percent (100 % su rvival rate).
Weight mea surem ent: Each rat’s daily postoperative

body weight changes were monitored with a weighing Fig.1: The differences in average preoperative and
scale (Salton E mperor®). postoperative body weights changes in polypropylene
group compared with polyglactin 910
Evaluation of intraabdominal adhesions: Two rats from
each group were euthanized at days 3, 5,7,11 with diethyl
ether and their enterotomy sites and adjacent visceral
surfaces evaluated for evidence of adhesion. Observed
adhesions were scored according to Granat adhesion score
(Granat et al., 1983).
Histopathological examination: A section of intestinal

tissues including the enterotomy sites was harvested from
each rat into 10% formalin, processed and stained w ith
haem atoxy lin and eosin, and ev aluated with light Fig. 2: Inflammatory cell responses to polypropylene and
polyglactin 910 using simple interrupted suture pattern
microscope. The numbers of inflammatory cells and
fibroblasts observed were scored base d on their density on
each field as earlier described by Sahin et al. (2001 ).
Statistical analysis: The t-test was used to comparison of

mean differences in both groups. A <0.005 was
considered statistically significant.
RESULTS
Figure 1 shows the differences in average

preoperative and postoperative body weights chan ges in
polypropylene group compared with polyglactin 910.
Both groups record ed a fall in body weight, w ith
polypropylene group loosing an average of 10.3g
between 3 to 11 days post- surgery. Fig. 3: Fibroblast responses to wound closure with
Figure 2, Plate 1 and 2 show the inflammatory cell polypropylene and polyglactin 910 using simple
responses to polypropylene and polyglactin 910 using interrupted suture pattern
simple interrupted suture pattern. Polyglactin 910
exhibited a lower response at day 3 but a higher response
at days 4 and 7 . The response to both suture materials fell
below the initial levels at day 11. The difference in
inflammatory cell response was not significant (p>0.05)
Fibroblast responses to wound closure with
polypropylene and polyglac tin 910 using simple
interrupted suture pattern are shown in Fig . 3, Plate 1 and
2. Polypropylene had a consistently higher adhesion score
(p<0.05) at days 3, 7 and 10 when compared with
polyglactin 910.
Figure 4 shows adhe sion sc ores in wound closed with Fig. 4: Adhesion scores for wound closed with polypropylene
polypropylene and polyglactin 910 using simple and polyglactin 910 using simple interrupted suture
interrup ted suture patterns. pattern
73
N = Neutrophils, F = Fibroblasts
Plate 1: Micrographs sections showing inflammatory cells and fibroblast response to enterotomy closure with polypropylene
using simple interrupted pattern at postoperative day 5 (x400)
N = Neutrophils, F = Fibroblasts
Plate 2: Micrographs sections showing inflammatory cells and fibroblast response to enterotomy closure with Polyglactin 910
using simple interrupted pattern at postoperative day 5 (x400)
DISCUSSION during the inflammatory phase of wound healing,

although the fibrin clot also offers some degree of wound
The result of the study shows the effects of support on the first postoperative day (Ellison, 1989;
polypropylene and polyglactin 910 on enterotomy wound Baines, 2000a). The inflammatory phase has been
healing using a simple interrupted suture pattern. Wound reported to be the most critical period of intestinal wound
healing follow ing intestinal injury is of potential healing, since most dehiscences take place within 72 to 98
importance to the surgeon since wound dehiscence of an h follow ing intestinal wound creation (Ralphs et al., 2003;
intestinal anastomo sis often leads to bacterial peritonitis Ellison, 1989; B aines, 2000 a). How ever, in this study the
and subsequent death (Ellison, 1989; Allen et al., 1992; mortality rate was zero sho wing that the rats fare w ell
Ralphs et al., 2003). The lag or inflammatory phase of through this period. Moreover, the lower inflammatory
healing commences immediately following intestinal cell response in the polypropylene group could be a
injury and last three to four days (Ellison, 1989). The reflection of the relative inertness of polypropylene,
observed prolongation of the inflammatory phase until the which had earlier been reported (Boothe, 1985; Sahin
fifth day may be du e to inflammatory cell response to et al., 2001 ). The result of fibrop lasia as observed in this
infection since the rats were not on antibiotics before or study is consistent with similar finding by other
after the surgery (Fig. 2). It has been reported that sutures investigators (Peac ock, 1984). Rapid proliferation of
used for apposition of wound edge s offer the main support fibroblast occurs between the 3rd and 14th day of
74
intestinal injury resulting in production of large amount of Boothe, H.W ., 1985. Suture Materials and Adhesives. In:
collagen and rapid gain of wound strength (Peacock, Slatter, D.H. (Ed.), Textbook of Small Animal
1984; Ellison, 1989 ; Baines, 2000a). At the end of 14 Surgery. Philadelphia, WB Saunders, pp: 334.
days, small intestinal wound bursting strength is Ellison, G.W., 1989. Wound healing in gastrointestinal
approximately 75% of normal tissues (Ellison, 1989). In tract. Semin. Vet. Med. Surg., 4: 287.
this study, there is an observed relationship between the Eyarefe, O.D., S.O. Oni and J.F. Akinrinmade, 2001.
higher fibroplasia and the adhesion observed in the Clinicopathological features of massive small
polypropylene group. Sinc e fibrob lasts are the precursors intestinal resection in Nigeria’s Local Breeds of Cats.
of collagen also involved adhe sion, the highe r fibroplasia Afr. J. Biomed. Res., 4: 33-37.
may be due to the sev ere adhesion observed in this group.
Eyarefe, O.D., B.O. Emikpe and O.A. Arowolo, 2008.
Furthermore, rats in the two groups had initial slight
Small bowel responses to enteral honey and
body weight loss betw een d ays 0 and 3 that ma y be d ue to
Glutamine administration following small bowel
catabolic weight loss from surgical stress and wound
resection in rabbits. J. Medic. M ed. Sci., 37(4):
healing (Eyarefe, 2001). However, the consistent and
prolonged weight loss in polypropylene group (Fig. 1) 309-314.
could be attributed to reduced intake of food and water Fossum, T.W ., C.S. Hedlund, D.A. Hulse, A.L. Johnson,
precipitated by the postoperative pain induced by the H.B. Seim , M.D. W ilfard and G.L. Carrol, 2002.
severe adhesion (Frec kne ll, 1989) observed in Surgery of the digestive system in small animal
polyp ropylene group. surge ry. M osby . St Louis, pp: 274-4 49.
Frecknell, P.A., 1989. Management of Postoperative pain
CONCLUSION in Labouratory Animal Aneasthesia: An Introduction
to Resea rch W orkers and Technicians. A cade mic
Although polypropylene possesses attributes of an Press Inc., San Diego, C A., pp : 83.
ideal suture, as could be observed in this study, it may be Granat, M., I. Tur-kespa, E. Zylber-Katz and
postulated that its use for enterotomy closure with the J.C. Schenker, 1983. Reduction of peritoneal
conventional simple interrupted sutures may not be adhesion formation by C alchicine in comp arative in
advisable. The authors are of the opinion that the several a rat. Fertil. Steril., 40: 369-372.
knots characteristic of the simple interrupted p attern may Peacock, E.E., 1984. The Gastro Intestinal Tract: Surgery
be contributory to the observed adhesion in the and Biolo gy of W ound Repair. 3rd Edn., W B
polyp ropylene group. Saunders, Philadelphia.
Ralphs, S.C., C.R. Jessen and A.J. Lipowitz, 2003. Risk
REFERENCES
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75

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International Journal of Animal and Veterinary Advance 2(3): 72-75, 2010

Small Bowel Wall Response to Enterotomy Closure with Polypropylene and

O.D . Eyarefe and S .A. A mid

Key w ords: Closure, enterotomy, interrupted pattern, polyglactin 910, polypropylene

INTRODUCTION there is a dearth of empirical verification in literature on

located, exteriorized, and a 1.0 cm enterotomy was made

Weight mea surem ent: Each rat’s daily postoperative

Histopathological examination: A section of intestinal

Statistical analysis: The t-test was used to comparison of

Figure 1 shows the differences in average

DISCUSSION during the inflammatory phase of wound healing,

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