Abstract
Background
Porcine models are well established for studying intestinal anastomotic healing. In this study, we aimed to clarify the anatomic differences between human and porcine small intestines. Additionally, we investigated the influences of longitudinal and circular sutures on human small intestine perfusion.
Methods
Intestines were obtained from human cadavers (n = 8; small intestine, n = 51) and from pigs (n = 10; small intestine, n = 60). Vascularization was visualized with mennige gelatin perfusion and high-resolution mammography. Endothelial cell density was analyzed with immunohistochemistry and factor VIII antibodies. We also investigated the influence of suture techniques (circular anastomoses, n = 19; longitudinal sutures, n = 15) on vascular perfusion.
Results
Only human samples showed branching of mesenteric vessels. Compared to the pig, human vessels showed closer connections at the entrance to the bowel wall (p = 0.045) and higher numbers of intramural anastomoses (p < 0.001). Porcine main vessels formed in multifilament-like vessel bundles and displayed few intramural vessel anastomoses. Circular anastomoses induced a circular perfusion defect at the bowel wall; longitudinal anastomoses induced significantly smaller perfusion defects (p < 0.001). Both species showed higher vascular density in the jejunum than in the ileum (p < 0.001). Human samples showed similar vascular density within the jejunum (p = 0.583) and higher density in the ileum (p < 0.001) compared to pig samples.
Conclusion
The results showed significant differences between human and porcine intestines. The porcine model remains the standard for studies on anastomotic healing because it is currently the only viable model for studying anastomosis and wound healing. Nevertheless, scientific interpretations must consider the anatomic differences between humans and porcine intestines.
Similar content being viewed by others
References
Federal Statistical Office (2004) Health-medical costs 2002. Federal Statistical Office—Press Office Wiesbaden
Federal Statistical Office (2004) Diagnosisdata of hospital patients 2002. Federal Statistical Office—Pressoffice Wiesbaden
Cihan A, Acun Z, Ucan BH, Numanoglu VK, Armutcu F, Gurel A, Ulukent SC (2003) Comparison of the experimental intestinal anastomoses performed by different surgeons. Hepatogastroenterology 50(Suppl 2):ccxxxv–ccxxxvii
Stumpf M, Klinge U, Mertens PR (2004) Anastomotic leakage in the gastrointestinal tract-repair and prognosis. Chirurg 75:1056–1062
Willis S, Stumpf M (2004) Leakages after surgery of the lower gastrointestinal tract. Chirurg 75:1071–1078
Stumpf M, Klinge U, Wilms A, Zabrocki R, Rosch R, Junge K, Krones C, Schumpelick V (2005) Changes of the extracellular matrix as a risk factor for anastomotic leakage after large bowel surgery. Surgery 137:229–234
Press Office Helios clinics—Fulda (2002) Helios Kliniken Gruppe Kompetenz in Medizin. Annual medical report 2001
Stumpf M, Cao W, Klinge U, Klosterhalfen B, Kasperk R, Schumpelick V (2002) Collagen distribution and expression of matrix metalloproteinases 1 and 13 in patients with anastomotic leakage after large-bowel surgery. Langenbeck’s Arch Surg 386:502–506
Akasu T, Takawa M, Yamamoto S, Yamaguchi T, Fujita S, Moriya Y (2010) Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma. J Gastrointest Surg 14:104–111
Kube R, Mroczkowski P, Steinert R, Sahm M, Schmidt U, Gastinger I, Lippert H (2009) Anastomotic leakage following bowel resections for colon cancer: multivariate analysis of risk factors. Chirurg 80:1153–1159
Stumpf M, Junge K, Wendlandt M, Krones C, Ulmer F, Klinge U, Schumpelick V (2009) Risk factors for anastomotic leakage after colorectal surgery. Zentralbl Chir 134:242–248
Senagore A, Milsom JW, Walshaw RK, Dunstan R, Mazier WP, Chaudry IH (1990) Intramural pH: a quantitative measurement for predicting colorectal anastomotic healing. Dis Colon Rectum 33:175–179
Sorensen LT, Jorgensen T, Kirkeby LT, Skovdal J, Vennits B, Wille-Jorgensen P (1999) Smoking and alcohol abuse are major risk factors for anastomotic leakage in colorectal surgery. Br J Surg 86:927–931
Vignali A, Gianotti L, Braga M, Radaelli G, Malvezzi L, Di C (2000) V Altered microperfusion at the rectal stump is predictive for rectal anastomotic leak. Dis Colon Rectum 43:76–82
Lang J, Heichele J (1982) Über die Gefäße des Dünndarms. Morphol Med 2:207
Jonsson T, Hogstrom H (1992) Effect of suture technique on early healing of intestinal anastomoses in rats. Eur J Surg 158:267–270
Willis S, Holzl F, Krones CJ, Tittel A, Schumpelick V (2006) Evaluation of anastomotic microcirculation after low anterior rectal resection: an experimental study with different reconstruction forms in dogs. Tech Coloproctol 10:222–226
Michels NA, Siddhardt P, Kornblith PL, Parke WW (1963) The variant blood supply to the small and large intestines: its import in regional resections. J Int Coll Surg 39:127–170
Vandamme JP, Bonte J (1982) A new look at the blood supply of the ileocolic angle. Acta Anat (Basel) 113:1–14
von Ruggeri ZM (1993) Willebrand factor and fibrinogen. Curr Opin Cell Biol 5:898–906
von Rodeghiero F (2002) Willebrand disease: still an intriguing disorder in the era of molecular medicine. Haemophilia 8:292–300
Vignali A, Fazio VW, Lavery IC, Milsom JW, Church JM, Hull TL, Strong SA, Oakley JR (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1,014 patients. J Am Coll Surg 185:105–113
Hogstrom H, Haglund U, Zederfeldt B (1985) Suture technique and early breaking strength of intestinal anastomoses and laparotomy wounds. Acta Chir Scand 151:441–443
Waninger J, Kauffmann GW, Shah IA, Farthmann EH (1992) Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses. Am J Surg 163:319–323
Billings PJ, Foster ME, Leaper DJ (1986) A clinical and experimental study of colostomy blood flow and healing after closure. Int J Colorectal Dis 1:108–112
Thompson JS, Bragg LE, West WW (1990) Serum enzyme levels during intestinal ischemia. Ann Surg 211:369–373
Kurland B, Brandt LJ, Delany HM (1992) Diagnostic tests for intestinal ischemia. Surg Clin N Am 72:85–105
Mizock BA, Falk JL (1992) Lactic acidosis in critical illness. Crit Care Med 20:80–93
Sailer M, Debus ES, Fuchs KH, Beyerlein J, Thiede A (2000) Comparison of anastomotic microcirculation in coloanal J-pouches versus straight and side-to-end coloanal reconstruction: an experimental study in the pig. Int J Color Dis 15:114–117
Caglayan F, Caglayan O, Gunel E, Elcuman Y, Cakmak M (2002) Intestinal ischemia–reperfusion and plasma enzyme levels. Pediatr Surg Int 18:255–257
Pargger H, Staender S, Studer W, Schellscheidt O, Mihatsch MJ, Scheidegger D, Skarvan K (1997) Occlusive mesenteric ischemia and its effects on jejunal intramucosal pH, mesenteric oxygen consumption and oxygen tensions from surfaces of the jejunum in anesthetized pigs. Intensive Care Med 23:91–99
Brandt LJ, Boley SJ (2000) AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 118:954–968
Sato A, Kuwabara Y, Sugiura M, Seo Y, Fujii Y (1999) Intestinal energy metabolism during ischemia and reperfusion. J Surg Res 82:261–267
Hansen HH, Stelzner F (1975) Surgical anatomy of the blood supply of the colon (author’s transl). Langenbecks Arch Chir 340:63–74
Spalding H, Heath T (1987) Arterial supply to the pig intestine: an unusual pattern in the mesentery. Anat Rec 218:27–29
Spalding HJ, Heath TJ (1986) Blood vessels of lymph nodes in the pig. Res Vet Sci 41:196–199
Sommerova J (1980) Contribution to the comparative anatomy of jejunoileal arcades in mammals. Folia Morphol (Praha) 28:282–285
Chiba T, Boles ET Jr (1984) Studies on the relationship between the number of arteriae rectae of intestinal artery and intestinal length. Tohoku J Exp Med 143:27–31
Semeraro D, Davies JD (1986) The arterial blood supply of human inguinal and mesenteric lymph nodes. J Anat 144:221–233
Schummer A, Wilkens H, Vollmershaus B, Habermehl KH (1981) The anatomy of domestic animals. Parey, Berlin
Jodal M, Lundgren O (1986) Countercurrent mechanisms in the mammalian gastrointestinal tract. Gastroenterology 91:225–241
Myers MB, Cherry G (1969) Use of vital dyes in the evaluation of the blood supply of the colon. Surg Gynecol Obstet 128:97–102
Hansen HH, Heine H (1976) Blood supply and histophysiology of the appendices epiploicae (author’s transl). Langenbecks Arch Chir 340:191–197
Al-Fallouji MA, Tagart RE (1985) The surgical anatomy of the colonic intramural blood supply and its influence on colorectal anastomosis. J R Coll Surg Edinb 30:380–385
Kleinfeld G, Gump FE (1960) Complications of colotomy and polypectomy. Surg Gynecol Obstet 111:726–728
SWINTON NW, WEAKLEY FL (1963) Complications of colotomy and colonoscopy. Dis Colon Rectum 6:50–53
Knutson CO, Schrock LG, Polk HC Jr (1974) Polypoid lesions of the proximal colon: comparison of experiences with removal at laparotomy and by colonoscopy. Ann Surg 179:657–662
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
von Trotha, KT., Butz, N., Grommes, J. et al. Vascular anatomy of the small intestine—a comparative anatomic study on humans and pigs. Int J Colorectal Dis 30, 683–690 (2015). https://doi.org/10.1007/s00384-015-2163-4
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00384-015-2163-4