PEDICLE GRAFTS OF PERITONEUM AND TRANSVERSALIS MUSCLE FOR THE REPAIR OF LARGE DEFECTS IN THE DUODENAL WALL

Objective-To find out if pedicle grafts of peritoneum and transversalis muscle could be used to repair large defects in the wall of the duodenum. Design-Experimental study. Material-18 healthy mongrel dogs. Interventions-Defects were created in the second part of duodenum and repaired with pedicle grafts of peritoneum and transversalis muscle from the anterior wall of the right side of the abdomen. Main outcome measures-Postoperative complications, appearances on upper gastrointestinal radiography two and four months after operation, and histological examination of necropsy specimens. Results-There were no postoperative deaths or complications. Radiographs of the duodenum showed no abnormalities and in particular no signs of obstruction. Animals were killed at intervals from one week to eight months after operation, and the only abnormality was 20-30% stenosis found in five dogs killed within two months of operation, which did not affect gastric emptying. Histological examination showed that by four months after operation the patch was completely covered by neomucosa that was similar to normal duodenal mucosa. By six months the site of the defect was well healed and the histological appearance was the same as at four months. Conclusion-Pedicle grafts of peritoneum and transversalis muscle may be useful in the treatment of patients with large defects in the wall of the duodenum.