Physical and biologic impermeability of intestinal sutures in the first twenty-four hours after operations on the gastrointestinal tract

Abstract

The author has substantiated a concept that in the general notion of the impermeability of intestinal sutures, it is necessary to distinguish between physical impermeability (imperviousness of sutures to liquids and gases) and biologic impermeability (imperviousness of sutures to microbes and toxins). It was established in experiments on 165 dogs that infection that invaded peritoneum during operation disappeared from the peritoneal cavity within an hour of small-bowel and stomach surgery and within 1 1/2 hours of colon surgery. Then a period of sterility of peritoneum was observed, which lasted for 8 to 9 hours after operations on the stomach and the small bowel (p = 0.01) and for 4 to 7 hours after operations on the colon (p = 0.01). In the following hours the peritoneal cavity was infected through physically hermetic intestinal sutures. At the end of 24 hours the peritoneum of operated organs showed the presence of 10(4) to 10(6) intestinal microbes. Greater omentum, bowel loops, and their mesentery adhered to the suture in response to the infection through the suture. Complete covering of the suture with adjacent viscera prevented infection of the peritoneal cavity through the suture. The author suggests a well-grounded concept of the leading role of infection through a physically hermetic intestinal suture in the development of postoperative peritonitis and peritoneal adhesions.