Autologous Parietal Peritoneal Patch for Repair of Intestinal Perforations : An Experimental Study in a Canine Model

Autologous Parietal Peritoneal Patch for Repair of Intestinal Perforations : An Experimental Study in a Canine Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Autologous Parietal Peritoneal Patch for Repair of Intestinal Perforations : An Experimental Study in a Canine Model Aymen Mabrouk, Adamou Sahidi, Laila Jedidi, Blel Ahlem, Yacine Ben Safta, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6986529/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Intestinal perforation is a surgical emergency associated with a significant morbidity and mortality. Current repair techniques such as primary suturing may be inefficient. The aim of this study was to evaluate the efficacy of autologous parietal peritoneal patch for the repair of small intestinal perforations. Twelve dogs were randomly assigned to two groups: Group A (n = 6) underwent repair using a parietal peritoneal patch, while Group B (n = 6) received conventional primary suturing. Animals were monitored clinically for 8 weeks. At endpoint, macroscopic and histological outcomes were assessed. All 12 dogs survived without major complications. The peritoneal patch group showed organized healing with neomucosal regeneration, minimal adhesions, and no stricture formation. In contrast, the control group showed more extensive adhesions, fibrosis, and stricture formation. Histological examination confirmed mature granulation tissue and epithelial coverage in Group A. Autologous parietal peritoneal patch offers a promising, biologically compatible technique for intestinal perforation repair. Compared to primary suturing, this approach reduced adhesions and enhanced tissue healing. Further studies are needed to validate its potential in gastrointestinal surgery. intestinal perforation intestinal repair parietal peritoneum peritoneal patch Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Effective control of leakage remains a major challenge to surgical success in the treatment of intestinal perforation 1 . With small lesions or minor disruptions (up to 20% of the intestinal circumference), primary closure usually results in good outcomes 2 . Yet, in the case of larger defects (50% of the circumference), especially in the non-mobilizable regions like the duodenum and colon, primary sutures or resections should not be used 3 . The reason is that the risk of producing too much tension on the suture line and eventually leading to stenosis and leakage is high 4 . In such situations, the use of a graft is required for optimal repair of the lesions while maintaining intestinal integrity 5 . Ongoing research is focused on identifying safe and effective grafts 1 . Nonetheless, several limitations have been noted regarding their application, including issues related to availability, acquisition time, and the potential for adhesions to adjacent organs 6 , 7 . In this context, the application of peritoneal patches has been developed, especially to correct vascular defects 8 , 9 . The peritoneum is easily accessible and possesses high regenerative potential. Moreover, it is derived from the same stem cells that form the mesoderm and endothelium and therefore a suitable material for reconstructive surgery with large intestinal perforation 10 . The aim of our study is to assess the effectiveness of peritoneal patches in the repair of large intestinal perforations. METHODS This study was conducted at the Surgery Department of the National Veterinary School of Sidi Thabet in collaboration with the faculty of medecine of Tunis,Tunisia, following prior authorization from the institutional Ethics Committee. Tweleve stray dogs weighing at least 30 kg were randomly selected and enrolled in this study. They were quarantined, dewormed, and vaccinated. After a quarantine period of 14 days, the dogs were randomly divided into two groups : 6 dogs for the experimental group (group A) and 6 dogs for the control group (group B). After fasting for 24 hours prior to the intervention, the dogs received subcutaneous atropine, 0.1 mg/kg and acepromazine, 0.25 mg/kg. The abdominal area was shaved and general anaesthesia was induced by administration of intravenous ketanime, 15 mg/kg of body weight. Under aseptic conditions, a midline laparotomy incision was made. The antimesenteric surface of the small bowel was exposed, approximately 20 cm distal to the duodenojejunal flexure, and a 2 cm defect was created with a scalpel In the group A, the perforation was repaired using a parietal peritoneal patch of about 3 cm harvested from the posterior fascia of the rectus abdominis muscle. The graft was sutured on with 4/0 polyglactin (circle atraumatic needle), covering the defect (Fig. 1 ). In the group B, the defect was repaired by a simple sutures using 4/0 polyglactin. All the animals were kept fasted for 24 hours after the surgery and nutrition was provided by subcutaneous 5% glucose. Ampicilin (25 mg/kg/12 hours) and tramadol (5 mg/kg/day) were administred until the 7th postoperative day. Continous monitoring was kept during 8 weeks. On the 5th postoperative day, a labrotory test were conducted to evaluate the evolution. All animals were either underwent a second intervention immediately after a complication or explored once more 8 weeks after closure. Therefore, in all cases the site of intestinal repair was removed, followed by an anastomosis. Histological evaluation was done by a pathologist who was blinded to the study. The data were recorded in Excel®; values are expressed as mean+/-standard deviation. Data were analyzed by using ANOVA, and the Mann-Whitney U test was used for the analysis of histopathology data. All authors complied with the ARRIVE guidelines. RESULTS All 12 dogs survived the initial surgical procedure and completed the 8-week follow-up. All dogs displayed normal eating and drinking behavior througout the study. No signs of peritonitis or sepsis were observed in either group. One dog in Group A developed abdominal evisceration on day 3 and underwent immediate surgical repair and another dog developed cyctitis. Group B showed a higher incidence of postoperative ileus, which resolved spontaneously within 48 hours. All dogs gained weight without significant difference. Macroscopic examination : At the 8-week re-exploration, in the Group A, the intraoperative evaluation showed the disappearance of the parietal peritoneal harvest site and consolidated repair site. Minimal adhesions were found in three cases, with no signs of stricture formation or dilated bowels (Fig. 2 ) Conversely, the control group showed adhesions in two of six dogs and strictured formation in all cases (Fig. 3 ). No postoperative complications or deaths were observed in either group. Histological examination : Histological examination of the intestinal repair site showed mature granulation tissue localized at the patch suture area with neomucosal coverage compared to adjacent tissue in Group A (Fig. 4 ). However, the control group presented more massive fibrin deposition accompanied by inflamatory infiltration of the subserosa and regenerative mucosa (Fig. 5 ). The repair site was not recognizable. DISCUSSION Small bowel perforation is a severe complicaton and is associated with significant morbidity and mortality 11 . Conventional suture techniques may be simpler to use but may not be always feasible in case of larger defects or friable tissue conditions 12 . Therefore, identifying a safe and feasible methods for repairing intestinal perforation can markedly improve surgical outcomes by reducing the risk of leakage. Our experimental study evaluated the effectiveness of the parietal peritoneal patch for repairing small bowel perforations in an animal model. Our findings revealed that using a peritoneal graft restored intestinal integrity and improved outcomes, both macroscopically and histologically, with fewer postoperative complications. Compared to the control group, the experimental group showed reduced adhesion formation and absence of stricture. In addition, more mature granulation tissue and neomucosal coverage at the repair site were observed. Parietal peritoneum was chosen based on its ready availability and its origin. Its mesothelium originates embryologically from the same stem cell as the intestinal wall. In fact, mesothelial cells produce several cytokines, growth factors and extracellular matrix components, possessing anti-inflammatory and immunomodulatory properties, which gives its regenerative potential 13 . Besides, parietal peritoneum offers an easily accessible solution, especially in emergency situations 11 , 14 . In our study, picking the parietal peritoneum was technically practical and didn’t cause complications at the donor site. By the 8-week endpoint, the harvest site was no longer distinguishable macroscopically. Peritoneum has been used as a graft material since 1901. Carrel 15 was the first who reported the use of peritoneal tissue as a vascular patch in experimental arterial reconstruction. Since then, other authors described their experience, demonstrating the resistance and suitability of the parietal peritoneum as a vascular substitute 1 , 8 , 9 . Recently, it is considered as a safe option for the reconstruction of portal vein and vena cava 16 , 17 . Given its established role in vascular surgery, the peritoneal graft has also been explored as a solution in gastrointestinal repair. Orda et al. 18 were among the first to demonstrate the feasibility of peritoneal graft for the repair of intestinal perforation using butyl 2-cyanoacrylate monomer in an animal model, with no significant complications. Despite these results, there remains a lack of studies investigating the role of peritoneum as a graft material for the repair of intestinal perforation, particularly in cases of large perforation. Yin 11 reported that free peritoneal graft was an effective alternative for the repair of severe seromuscular defects of the colon, rectum, duodenum and small intestine. More recently, Castillo et al. 13 reported promising results using the peritoneal patch for grade III duodenal injury. Their study revealed that this biological grafts were tolerated, integrated into the duodenal wall, and promoted mucosal and muscular regeneration without complications such as fistulas or leaks. These results align with our findings, where using a parietal peritoneal patch for intestinal perforations led to the restoration of intestinal integrity, minimal adhesion formation, and mature granulation tissue at the repair site. In another animal study, Raffea et Allawi 19 strengthened the evidence supporting the utility of peritoneum graft in enhancing jejunal anastomotic healing. They reported faster re-epithelization of mucosa, increased collagen deposition, fibroblast proliferation, reduced adhesions, and decreased stenosis degree compared to sutures alone. In all these studies 11 , 13 , 19 , the use of peritoneal graft was associated with reduced adhesion formation, consistent with our outcomes. In fact, the efficacy of parietal peritoneal patch in preventing postoperative adhesion has been previosuly reported in different studies 20 , 21 . Bresson et al. 22 revealed that autologous peritoneal grafts in rats enhance reperitonealization and significantly reduced postoperatives adhesion. In contrast, other studies investigated the efficacy of synthetic materials for intestinal repair. However, less favorable outcomes were reported compared to sutures alone 23 . These findings further demonstrate the importance of using biological grafts, such as parietal peritoneum, as reported in our study. This experimental study has several limitations. The sample size was small, and one single animal model was used. Thus, further validation in other species is needed before results can be directly translated to humans. In addition, the 8-week follow-up period didn’t allow long-term assessment. Although our study reported macroscopic and histological outcomes, molecular analyses were not performed, which limits the understanding of the mechanisms underlying the effectiveness of peritoneal graft. Finally, the study didn’t include comparison with other biological or synthetic grafts. Further researchs, with larger cohort and long-term follow-up are necessary to validate these outcomes and prove the clinical potential of this technique. CONCLUSION This experimental study highlights the efficacy of parietal peritoneum as a graft for intestinal perforation repair. It is considered a safe and accessible option in emergency surgeries. However, further studies with larger cohort and long-term follow-up are required to provide conclusive evidence and explore the clinical application of this technique in human surgery. Declarations Competing interests The authors declare no competing interests. Ethics/Ethical Approval : This study was approved by the Institutional Ethics Committee of the National School of Veterinary Medicine of Sidi Thabet Funding: No funding or sponsorship was received for this study or publication of this article. Author Contribution A.B an Y.B.S: Conceptualization and study design. A.S and L.J substantially contributed to the conception and design of the study and interpretation of data. A.S, B.A, S.R, and R.L conducted the data analysis. L.J wrote the main manuscript text. F.E and W.T revised the work. Manuscript correction and validation: M.B.M, N.B.C, and S.B validated the final manuscript. ACKNOWLEDGEMENTS We thank the contributors in this study Data Availability The data sets generated and analysed during the present study are available from the corresponding author upon reasonable request. References Dokmak, S. et al. Parietal Peritoneum as an Autologous Substitute for Venous Reconstruction in Hepatopancreatobiliary Surgery. Ann Surg 262 , 366–371 (2015). Atilla, A. Gastrointestinal surgery — some tips and tricks. Companion Animal 22 , 332–337 (2017). Walley, B. D. & Goco, I. Duodenal patch grafting. Am J Surg 140 , 706–708 (1980). Aslan, A. & Elpek, O. The repair of a large duodenal defect by a pedicled gastric seromuscular flap. Surg Today 39 , 689–694 (2009). Eckert, M. J. et al. Bioprosthetic repair of complex duodenal injury in a porcine model. J Trauma 66 , 103–109 (2009). Hosseini, S. V., Abbasi, H. R., Rezvani, H., Vasei, M. & Ashraf, M. J. Comparison between Gallbladder Serosal and Mucosal Patch in Duodenal Injuries Repair in Dogs. Journal of Investigative Surgery 22 , 148–153 (2009). Simpson, M. & Hall, J. L. Transversus abdominis muscle as a gastric or intestinal on-lay flap in two dogs and one cat. J Small Anim Pract 62 , 918–923 (2021). Kayaalp, C., Sumer, F., Polat, Y. & Kutlu, R. Autologous Peritoneum Graft Repair of a Superior Mesenteric Vein Defect During Pancreaticoduodenectomy. Cureus 7 , e340 (2015). Yoshioka, M. et al. Reconstruction of the portal vein using a peritoneal patch-graft. Am J Surg 181 , 247–250 (2001). Whitaker, D., Papadimitriou, J. M. & Walters, M. N. The mesothelium and its reactions: a review. Crit Rev Toxicol 10 , 81–144 (1982). Yin, W.-Y. Free Peritoneal Graft for Repair of Severe Seromuscular Defect of Bowel: From Experiment to Clinical Practice. Journal of Surgical Research 125 , 3–8 (2005). Bielecki, K., Kamiński, P. & Klukowski, M. Large bowel perforation: morbidity and mortality. Tech Coloproctol 6 , 177–182 (2002). Castillo, J. M. et al. PARIETAL PERITONEUM GRAFT FOR DUODENUM INJURIES IN AN ANIMAL MODEL. ABCD, arq. bras. cir. dig. 32 , e1418 (2019). Meurisse, N., Ansart, F., Honoré, P. & De Roover, A. Glutaraldehyde-fixed parietal peritoneum graft conduit to replace completely the portal vein during pancreaticoduodenectomy: A case report. Int J Surg Case Rep 74 , 296–299 (2020). Carrel, A. PERITONEAL PATCHING OF THE AORTA. J Exp Med 12 , 139–145 (1910). Radulova-Mauersberger, O. et al. How we do it—the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery. Langenbecks Arch Surg 407 , 3819–3831 (2022). Labori, K. J. et al. Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery – A systematic review. HPB 23 , 483–494 (2021). Orda, R., Wiznitzer, T. & Nathan, H. Parietal-peritoneal patch for closure of intestinal perforations with butyl 2-cyanoacrylate monomer. Journal of Surgical Research 13 , 315–320 (1972). Raffea, N. M. & Allawi, A. H. Effect of autologous peritoneum and platelet-rich fibrin graft on healing of intestinal anastomosis in dogs. Iraqi Journal of Veterinary Sciences 36 , 459–470 (2022). Uema, R. T., Fazan, V. P. S., Cherri, J. & Piccinato, C. E. Bovine Peritoneum Protection Role on Intestinal Adhesions to a Vascular Graft: A Morphological Analysis. Int. J. Morphol. 26 , (2008). Laukka, M. et al. Preperitoneal Fat Grafting Inhibits the Formation of Intra-abdominal Adhesions in Mice. J Gastrointest Surg 24 , 2838–2848 (2020). Bresson, L., Leblanc, E., Lemaire, A. S., Okitsu, T. & Chai, F. Autologous peritoneal grafts permit rapid reperitonealization and prevent postoperative abdominal adhesions in an experimental rat study. Surgery 162 , 863–870 (2017). Wheeler, M. B. Patch Repair for Intestinal Perforation Closure in an Ex-Vivo Porcine Model with Burst Pressure Characterization. JRMBR 1–5 (2023) doi:10.46889/JRMBR.2023.4106. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6986529","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":514232204,"identity":"084c5ba2-b0cd-40c1-a4a2-29c84692879c","order_by":0,"name":"Aymen Mabrouk","email":"","orcid":"","institution":"Department of Surgery A21, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 9-Avril 1938 Boulevard, 1006","correspondingAuthor":false,"prefix":"","firstName":"Aymen","middleName":"","lastName":"Mabrouk","suffix":""},{"id":514232205,"identity":"8a3823fb-3c62-4180-b7cc-7445d74eb4ba","order_by":1,"name":"Adamou Sahidi","email":"","orcid":"","institution":"Inter-State School of Veterinary Science and Medicine","correspondingAuthor":false,"prefix":"","firstName":"Adamou","middleName":"","lastName":"Sahidi","suffix":""},{"id":514232206,"identity":"3b2bddd1-f52c-4b83-8d5a-75c53cdc6d0d","order_by":2,"name":"Laila Jedidi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIie3PsUoDMRzH8d9xkC7hsqZQ9BUigjjcw/xDoS4WHR1E4+LUB9C3qAjOOf60HbsenMtR6ORw4w0OXlsoLtfeKJjvEELIh38ChEJ/sATRkwcEwDC+SjsQgcjtSfYyggbi5pwOEcBvdx4mlp1Ij52vkZwki/iNU/p4gL6ZTaP6s51I67IJxHmfxS1fU6GhhyIHrQ88zDovIeyUpeFxvSfcTlTpsm+Ixy25pC5EW8fNFDIbgm6kdDww4uy1+Us2oaL/LFcXOY3aiVJXZfl1Nz9Nlvxe1VQo1bPrvErbyS4z/zV3s9AR0HR//EooFAr9334AQzBWPlanPJ8AAAAASUVORK5CYII=","orcid":"","institution":"faculty of medecine of Tunis- University of Tunis El Manar, surgery department- Regional Hospital of Jendouba","correspondingAuthor":true,"prefix":"","firstName":"Laila","middleName":"","lastName":"Jedidi","suffix":""},{"id":514232207,"identity":"fa9a7907-33fb-4c83-9f0e-d01c4b87db55","order_by":3,"name":"Blel Ahlem","email":"","orcid":"","institution":"University of Tunis El Manar","correspondingAuthor":false,"prefix":"","firstName":"Blel","middleName":"","lastName":"Ahlem","suffix":""},{"id":514232208,"identity":"5ee160be-6481-4d4c-9cef-2a7ca49a6713","order_by":4,"name":"Yacine Ben Safta","email":"","orcid":"","institution":"Department of Surgery A21, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 9-Avril 1938 Boulevard, 1006","correspondingAuthor":false,"prefix":"","firstName":"Yacine","middleName":"Ben","lastName":"Safta","suffix":""},{"id":514232209,"identity":"af46461f-875b-4201-86ed-af746f3e63dd","order_by":5,"name":"Rym Latrach","email":"","orcid":"","institution":"National School of Veterinary Medicine of Sidi Thabet","correspondingAuthor":false,"prefix":"","firstName":"Rym","middleName":"","lastName":"Latrach","suffix":""},{"id":514232210,"identity":"ba8d6cad-ae7f-4ab4-a744-7fd5720ffcec","order_by":6,"name":"Farouk Ennaceur","email":"","orcid":"","institution":"faculty of medecine of Tunis- University of Tunis El Manar, surgery department- regional hospital of Zaghouane","correspondingAuthor":false,"prefix":"","firstName":"Farouk","middleName":"","lastName":"Ennaceur","suffix":""},{"id":514232211,"identity":"adc68274-18b9-418a-a724-344757cf6cf7","order_by":7,"name":"Wissem Triki","email":"","orcid":"","institution":"Department of Surgery, Habib Bougatfa Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Hédi Saïdi Street, 7000","correspondingAuthor":false,"prefix":"","firstName":"Wissem","middleName":"","lastName":"Triki","suffix":""},{"id":514232212,"identity":"61803751-390a-409e-8ee0-bf24342833c7","order_by":8,"name":"Soumaya Rammeh","email":"","orcid":"","institution":"Department of anatomy and pathological cytology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 9-Avril 1938 Boulevard, 1006","correspondingAuthor":false,"prefix":"","firstName":"Soumaya","middleName":"","lastName":"Rammeh","suffix":""},{"id":514232213,"identity":"ca3fd6cf-97a7-4b81-806f-c544a1dcff75","order_by":9,"name":"Mounir Ben Moussa","email":"","orcid":"","institution":"Department of Surgery A21, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, 9-Avril 1938 Boulevard, 1006","correspondingAuthor":false,"prefix":"","firstName":"Mounir","middleName":"Ben","lastName":"Moussa","suffix":""},{"id":514232214,"identity":"79721e5e-f6f3-477a-b013-6d2d43fd370f","order_by":10,"name":"Noureddine Ben Chehida","email":"","orcid":"","institution":"Department of surgery , National School of Veterinary Medicine of Sidi Thabet, 2020 Sidi Thabet","correspondingAuthor":false,"prefix":"","firstName":"Noureddine","middleName":"Ben","lastName":"Chehida","suffix":""},{"id":514232215,"identity":"7b121668-4582-4a38-84a9-101c539223a9","order_by":11,"name":"Sami Bouchoucha","email":"","orcid":"","institution":"Department of Surgery, Habib Bougatfa Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Hédi Saïdi Street, 7000","correspondingAuthor":false,"prefix":"","firstName":"Sami","middleName":"","lastName":"Bouchoucha","suffix":""}],"badges":[],"createdAt":"2025-06-26 21:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6986529/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6986529/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93343001,"identity":"84be1f93-77db-41c3-8648-45cc4c1bbb45","added_by":"auto","created_at":"2025-10-12 14:45:51","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50164,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/118904b892ffabecf54667d8.docx"},{"id":93343013,"identity":"e50198bc-d38e-4c00-96f7-d5d00d501fcd","added_by":"auto","created_at":"2025-10-12 14:45:52","extension":"jpg","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50241507,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.4B.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/2a36c6cca4eb8fcee5c0ef0c.jpg"},{"id":93341079,"identity":"7e0d553f-db70-40f8-a49c-dcc86a962fa4","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"jpg","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73734,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/15bd7cf4f91976a4216416ae.jpg"},{"id":93341103,"identity":"97ff7245-3fed-4e57-b4bc-79817868273c","added_by":"auto","created_at":"2025-10-12 14:37:52","extension":"jpg","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60275224,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.4A.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/472959d3eaac80c0e19643d1.jpg"},{"id":93343004,"identity":"eb8641c7-0ace-44ce-a22f-9070cd1f974b","added_by":"auto","created_at":"2025-10-12 14:45:51","extension":"jpg","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":518043,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/96eae4722667c84c69fc4850.jpg"},{"id":93341084,"identity":"de5a8d56-89a8-4827-829f-4ff30a1ce24b","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"jpg","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88398,"visible":true,"origin":"","legend":"","description":"","filename":"fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/7239a593c5cbd1f112695ea8.jpg"},{"id":93343006,"identity":"51a98e22-59bf-469c-8e23-a8b4a29abad1","added_by":"auto","created_at":"2025-10-12 14:45:51","extension":"jpg","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":268889,"visible":true,"origin":"","legend":"","description":"","filename":"fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/f85999c33850cdfec6610ad4.jpg"},{"id":93343008,"identity":"707288b5-1a12-48b0-a64b-fa84a15a8690","added_by":"auto","created_at":"2025-10-12 14:45:51","extension":"json","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":11667,"visible":true,"origin":"","legend":"","description":"","filename":"79f439078d7a4b9faefa70f7b3dbedef.json","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/bb550dda98ca2f0efd48d38a.json"},{"id":93343012,"identity":"1e36fc27-994b-47bc-a0fd-fda042cd7e24","added_by":"auto","created_at":"2025-10-12 14:45:51","extension":"xml","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60135,"visible":true,"origin":"","legend":"","description":"","filename":"79f439078d7a4b9faefa70f7b3dbedef1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/468c44b1886edd412203faeb.xml"},{"id":93341104,"identity":"954b6eb1-d22c-4a5f-bbe1-0e72f3dd78d4","added_by":"auto","created_at":"2025-10-12 14:37:52","extension":"jpg","order_by":9,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":50241507,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.4B.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/bf39d6e313385f6d04978597.jpg"},{"id":93341091,"identity":"fbaf2880-b9d3-470d-b05a-5b06262771f2","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"jpg","order_by":10,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":73734,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/562d54e952b6c20f9f50bdc7.jpg"},{"id":93341105,"identity":"c0226ccb-e63f-43b9-babc-5ef5731eeefc","added_by":"auto","created_at":"2025-10-12 14:37:52","extension":"jpg","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60275224,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.4A.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/1d3422146d8a8b3ca9841a68.jpg"},{"id":93341100,"identity":"42ff6a47-9593-49c5-a372-3d785cd355a9","added_by":"auto","created_at":"2025-10-12 14:37:52","extension":"jpg","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":518043,"visible":true,"origin":"","legend":"","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/775b3365ab1644107ee9f105.jpg"},{"id":93343854,"identity":"3f8227f9-78be-4fad-945f-caf18ba58b37","added_by":"auto","created_at":"2025-10-12 14:53:51","extension":"jpg","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":88398,"visible":true,"origin":"","legend":"","description":"","filename":"fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/c3462db115c56dd809f6de0d.jpg"},{"id":93341093,"identity":"41fae384-d811-45f5-a565-c6accb66cc0b","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"jpg","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":268889,"visible":true,"origin":"","legend":"","description":"","filename":"fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/1c1491cad708cd974a0c9ff9.jpg"},{"id":93341101,"identity":"657af71a-c560-4f94-9394-93292807bf8e","added_by":"auto","created_at":"2025-10-12 14:37:52","extension":"png","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":8728883,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig.4B.png","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/38d3394f9c7f6e118b455e29.png"},{"id":93341087,"identity":"42ef048d-bf88-41c1-adca-0ffe1f3da6bf","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"png","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":74533,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig.1.png","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/ecfa7268f02b31d4e7117a52.png"},{"id":93343009,"identity":"f3421c69-d32f-4af8-a90e-a2ff33c5343c","added_by":"auto","created_at":"2025-10-12 14:45:51","extension":"png","order_by":17,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":6590958,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig.4A.png","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/9b2e3281b3be7490e668b521.png"},{"id":93343856,"identity":"1352ded6-5bb0-4767-aba9-96baa9418f9e","added_by":"auto","created_at":"2025-10-12 14:53:52","extension":"png","order_by":18,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":417976,"visible":true,"origin":"","legend":"","description":"","filename":"OnlineFig.5.png","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/fba6c5fbce589840de304af7.png"},{"id":93341090,"identity":"4b9b86fa-2f87-4fdb-a6ca-8f05e7254627","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"png","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97686,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefig.2.png","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/64afcfd97c7db8725f837760.png"},{"id":93341095,"identity":"612108c8-ab02-4528-984e-03b647991427","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"png","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":212661,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefig.3.png","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/3254e8f52797bd62c1a1e252.png"},{"id":93341097,"identity":"cd8983e5-e69e-4c8b-a909-28883c2af38a","added_by":"auto","created_at":"2025-10-12 14:37:52","extension":"xml","order_by":21,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":59090,"visible":true,"origin":"","legend":"","description":"","filename":"79f439078d7a4b9faefa70f7b3dbedef1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/b4e54a0640d3e697ca634855.xml"},{"id":93341099,"identity":"7a86d88e-89c6-4cfc-b988-8a064f0a438a","added_by":"auto","created_at":"2025-10-12 14:37:52","extension":"html","order_by":22,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":68398,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/d4326740a3fe442432761bd9.html"},{"id":93343851,"identity":"0c5e37c6-a815-4fe5-a8e2-5bf5c472185a","added_by":"auto","created_at":"2025-10-12 14:53:51","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":73734,"visible":true,"origin":"","legend":"\u003cp\u003eIntestinal repair site using the parietal peritoneal graft\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/f37a841bf8aeb9f0c9388cdc.jpg"},{"id":93341078,"identity":"d36fa3bb-4ccd-41c7-929d-59412337134d","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":88398,"visible":true,"origin":"","legend":"\u003cp\u003eMacroscopic appearanceof the small intestine 8 weeks after repair in Group A\u003c/p\u003e","description":"","filename":"fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/71d01b5ca66e1db746677f95.jpg"},{"id":93343855,"identity":"89ed043d-5f7d-47fb-8930-0691e307e56b","added_by":"auto","created_at":"2025-10-12 14:53:51","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":268889,"visible":true,"origin":"","legend":"\u003cp\u003eMacroscopic appearance of the small intestine 8 weeks after repair in Group B showing stricture formation (black arrow)\u003c/p\u003e","description":"","filename":"fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/c67e594a5e9074f9c78edafe.jpg"},{"id":93344057,"identity":"a9f8af66-f816-4e8c-b1ab-49d836de2472","added_by":"auto","created_at":"2025-10-12 15:01:51","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":708601,"visible":true,"origin":"","legend":"\u003cp\u003eHistological section of the small intestine repair site in Group A \u0026nbsp;8 weeks after the initial surgery (H\u0026amp;E x100). (A) The section shows continuous neomucosal coverage, mature granulation tissue (yellow arrow), and a well-integrated graft (black arrow). (B) The image shows dense connective tissue consistent with mature granulation (black arrow), along with vascular structures and minimal inflammatory infiltration.\u003c/p\u003e","description":"","filename":"Fig.4A.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/0b8f25e4249fd0b0df8da7a3.jpg"},{"id":93341083,"identity":"c5265474-fa4c-4c2b-9b49-05ab72a54b65","added_by":"auto","created_at":"2025-10-12 14:37:51","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":518043,"visible":true,"origin":"","legend":"\u003cp\u003eHistological section of the repair site in Group B 8 weeks after the initizl surgery. The section shows inflammatory reaction in the subserosa with abrasion of the mucosa (black star). (H\u0026amp;E x100)\u003c/p\u003e","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/4b247effb325386ca81ec177.jpg"},{"id":98774868,"identity":"b6180fe9-475d-49fe-a29e-c239a2ccaed0","added_by":"auto","created_at":"2025-12-22 12:15:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2132816,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6986529/v1/62023236-4bb5-4258-9bd4-da04c0433880.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Autologous Parietal Peritoneal Patch for Repair of Intestinal Perforations : An Experimental Study in a Canine Model","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEffective control of leakage remains a major challenge to surgical success in the treatment of intestinal perforation \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. With small lesions or minor disruptions (up to 20% of the intestinal circumference), primary closure usually results in good outcomes \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Yet, in the case of larger defects (50% of the circumference), especially in the non-mobilizable regions like the duodenum and colon, primary sutures or resections should not be used \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The reason is that the risk of producing too much tension on the suture line and eventually leading to stenosis and leakage is high \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn such situations, the use of a graft is required for optimal repair of the lesions while maintaining intestinal integrity \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Ongoing research is focused on identifying safe and effective grafts \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Nonetheless, several limitations have been noted regarding their application, including issues related to availability, acquisition time, and the potential for adhesions to adjacent organs \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In this context, the application of peritoneal patches has been developed, especially to correct vascular defects \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The peritoneum is easily accessible and possesses high regenerative potential. Moreover, it is derived from the same stem cells that form the mesoderm and endothelium and therefore a suitable material for reconstructive surgery with large intestinal perforation \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe aim of our study is to assess the effectiveness of peritoneal patches in the repair of large intestinal perforations.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e This study was conducted at the Surgery Department of the National Veterinary School of Sidi Thabet in collaboration with the faculty of medecine of Tunis,Tunisia, following prior authorization from the institutional Ethics Committee.\u003c/p\u003e\u003cp\u003eTweleve stray dogs weighing at least 30 kg were randomly selected and enrolled in this study. They were quarantined, dewormed, and vaccinated. After a quarantine period of 14 days, the dogs were randomly divided into two groups : 6 dogs for the experimental group (group A) and 6 dogs for the control group (group B).\u003c/p\u003e\u003cp\u003eAfter fasting for 24 hours prior to the intervention, the dogs received subcutaneous atropine, 0.1 mg/kg and acepromazine, 0.25 mg/kg. The abdominal area was shaved and general anaesthesia was induced by administration of intravenous ketanime, 15 mg/kg of body weight. Under aseptic conditions, a midline laparotomy incision was made. The antimesenteric surface of the small bowel was exposed, approximately 20 cm distal to the duodenojejunal flexure, and a 2 cm defect was created with a scalpel\u003c/p\u003e\u003cp\u003eIn the group A, the perforation was repaired using a parietal peritoneal patch of about 3 cm harvested from the posterior fascia of the rectus abdominis muscle. The graft was sutured on with 4/0 polyglactin (circle atraumatic needle), covering the defect (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the group B, the defect was repaired by a simple sutures using 4/0 polyglactin.\u003c/p\u003e\u003cp\u003eAll the animals were kept fasted for 24 hours after the surgery and nutrition was provided by subcutaneous 5% glucose. Ampicilin (25 mg/kg/12 hours) and tramadol (5 mg/kg/day) were administred until the 7th postoperative day. Continous monitoring was kept during 8 weeks. On the 5th postoperative day, a labrotory test were conducted to evaluate the evolution.\u003c/p\u003e\u003cp\u003eAll animals were either underwent a second intervention immediately after a complication or explored once more 8 weeks after closure. Therefore, in all cases the site of intestinal repair was removed, followed by an anastomosis. Histological evaluation was done by a pathologist who was blinded to the study.\u003c/p\u003e\u003cp\u003eThe data were recorded in Excel®; values are expressed as mean+/-standard deviation. Data were analyzed by using ANOVA, and the Mann-Whitney U test was used for the analysis of histopathology data.\u003c/p\u003e\u003cp\u003eAll authors complied with the ARRIVE guidelines.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eAll 12 dogs survived the initial surgical procedure and completed the 8-week follow-up. All dogs displayed normal eating and drinking behavior througout the study.\u003c/p\u003e\u003cp\u003eNo signs of peritonitis or sepsis were observed in either group. One dog in Group A developed abdominal evisceration on day 3 and underwent immediate surgical repair and another dog developed cyctitis. Group B showed a higher incidence of postoperative ileus, which resolved spontaneously within 48 hours. All dogs gained weight without significant difference.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMacroscopic examination\u003c/b\u003e :\u003c/p\u003e\u003cp\u003eAt the 8-week re-exploration, in the Group A, the intraoperative evaluation showed the disappearance of the parietal peritoneal harvest site and consolidated repair site. Minimal adhesions were found in three cases, with no signs of stricture formation or dilated bowels (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) Conversely, the control group showed adhesions in two of six dogs and strictured formation in all cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). No postoperative complications or deaths were observed in either group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eHistological examination\u003c/b\u003e :\u003c/p\u003e\u003cp\u003eHistological examination of the intestinal repair site showed mature granulation tissue localized at the patch suture area with neomucosal coverage compared to adjacent tissue in Group A (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). However, the control group presented more massive fibrin deposition accompanied by inflamatory infiltration of the subserosa and regenerative mucosa (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). The repair site was not recognizable.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eSmall bowel perforation is a severe complicaton and is associated with significant morbidity and mortality \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. Conventional suture techniques may be simpler to use but may not be always feasible in case of larger defects or friable tissue conditions \u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Therefore, identifying a safe and feasible methods for repairing intestinal perforation can markedly improve surgical outcomes by reducing the risk of leakage.\u003c/p\u003e\u003cp\u003eOur experimental study evaluated the effectiveness of the parietal peritoneal patch for repairing small bowel perforations in an animal model. Our findings revealed that using a peritoneal graft restored intestinal integrity and improved outcomes, both macroscopically and histologically, with fewer postoperative complications. Compared to the control group, the experimental group showed reduced adhesion formation and absence of stricture. In addition, more mature granulation tissue and neomucosal coverage at the repair site were observed.\u003c/p\u003e\u003cp\u003eParietal peritoneum was chosen based on its ready availability and its origin. Its mesothelium originates embryologically from the same stem cell as the intestinal wall. In fact, mesothelial cells produce several cytokines, growth factors and extracellular matrix components, possessing anti-inflammatory and immunomodulatory properties, which gives its regenerative potential \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Besides, parietal peritoneum offers an easily accessible solution, especially in emergency situations \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. In our study, picking the parietal peritoneum was technically practical and didn\u0026rsquo;t cause complications at the donor site. By the 8-week endpoint, the harvest site was no longer distinguishable macroscopically.\u003c/p\u003e\u003cp\u003ePeritoneum has been used as a graft material since 1901. Carrel \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e was the first who reported the use of peritoneal tissue as a vascular patch in experimental arterial reconstruction. Since then, other authors described their experience, demonstrating the resistance and suitability of the parietal peritoneum as a vascular substitute \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Recently, it is considered as a safe option for the reconstruction of portal vein and vena cava \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eGiven its established role in vascular surgery, the peritoneal graft has also been explored as a solution in gastrointestinal repair. Orda et al. \u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e were among the first to demonstrate the feasibility of peritoneal graft for the repair of intestinal perforation using butyl 2-cyanoacrylate monomer in an animal model, with no significant complications. Despite these results, there remains a lack of studies investigating the role of peritoneum as a graft material for the repair of intestinal perforation, particularly in cases of large perforation. Yin \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e reported that free peritoneal graft was an effective alternative for the repair of severe seromuscular defects of the colon, rectum, duodenum and small intestine.\u003c/p\u003e\u003cp\u003eMore recently, Castillo et al. \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e reported promising results using the peritoneal patch for grade III duodenal injury. Their study revealed that this biological grafts were tolerated, integrated into the duodenal wall, and promoted mucosal and muscular regeneration without complications such as fistulas or leaks. These results align with our findings, where using a parietal peritoneal patch for intestinal perforations led to the restoration of intestinal integrity, minimal adhesion formation, and mature granulation tissue at the repair site.\u003c/p\u003e\u003cp\u003eIn another animal study, Raffea et Allawi \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e strengthened the evidence supporting the utility of peritoneum graft in enhancing jejunal anastomotic healing. They reported faster re-epithelization of mucosa, increased collagen deposition, fibroblast proliferation, reduced adhesions, and decreased stenosis degree compared to sutures alone.\u003c/p\u003e\u003cp\u003eIn all these studies \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, the use of peritoneal graft was associated with reduced adhesion formation, consistent with our outcomes. In fact, the efficacy of parietal peritoneal patch in preventing postoperative adhesion has been previosuly reported in different studies \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Bresson et al. \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e revealed that autologous peritoneal grafts in rats enhance reperitonealization and significantly reduced postoperatives adhesion.\u003c/p\u003e\u003cp\u003eIn contrast, other studies investigated the efficacy of synthetic materials for intestinal repair. However, less favorable outcomes were reported compared to sutures alone \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. These findings further demonstrate the importance of using biological grafts, such as parietal peritoneum, as reported in our study.\u003c/p\u003e\u003cp\u003eThis experimental study has several limitations. The sample size was small, and one single animal model was used. Thus, further validation in other species is needed before results can be directly translated to humans. In addition, the 8-week follow-up period didn\u0026rsquo;t allow long-term assessment. Although our study reported macroscopic and histological outcomes, molecular analyses were not performed, which limits the understanding of the mechanisms underlying the effectiveness of peritoneal graft. Finally, the study didn\u0026rsquo;t include comparison with other biological or synthetic grafts. Further researchs, with larger cohort and long-term follow-up are necessary to validate these outcomes and prove the clinical potential of this technique.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis experimental study highlights the efficacy of parietal peritoneum as a graft for intestinal perforation repair. It is considered a safe and accessible option in emergency surgeries. However, further studies with larger cohort and long-term follow-up are required to provide conclusive evidence and explore the clinical application of this technique in human surgery.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eCompeting interests\u003c/h2\u003e\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthics/Ethical Approval :\u003c/h2\u003e\u003cp\u003e This study was approved by the Institutional Ethics Committee of the National School of Veterinary Medicine of Sidi Thabet\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNo funding or sponsorship was received for this study or publication of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.B an Y.B.S: Conceptualization and study design. A.S and L.J substantially contributed to the conception and design of the study and interpretation of data. A.S, B.A, S.R, and R.L conducted the data analysis. L.J wrote the main manuscript text. F.E and W.T revised the work. Manuscript correction and validation: M.B.M, N.B.C, and S.B validated the final manuscript.\u003c/p\u003e\u003ch2\u003eACKNOWLEDGEMENTS\u003c/h2\u003e\u003cp\u003eWe thank the contributors in this study\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data sets generated and analysed during the present study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eDokmak, S. \u003cem\u003eet al.\u003c/em\u003e Parietal Peritoneum as an Autologous Substitute for Venous Reconstruction in Hepatopancreatobiliary Surgery. \u003cem\u003eAnn Surg\u003c/em\u003e \u003cstrong\u003e262\u003c/strong\u003e, 366\u0026ndash;371 (2015).\u003c/li\u003e\n\u003cli\u003eAtilla, A. Gastrointestinal surgery \u0026mdash; some tips and tricks. \u003cem\u003eCompanion Animal\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 332\u0026ndash;337 (2017).\u003c/li\u003e\n\u003cli\u003eWalley, B. D. \u0026amp; Goco, I. Duodenal patch grafting. \u003cem\u003eAm J Surg\u003c/em\u003e \u003cstrong\u003e140\u003c/strong\u003e, 706\u0026ndash;708 (1980).\u003c/li\u003e\n\u003cli\u003eAslan, A. \u0026amp; Elpek, O. The repair of a large duodenal defect by a pedicled gastric seromuscular flap. \u003cem\u003eSurg Today\u003c/em\u003e \u003cstrong\u003e39\u003c/strong\u003e, 689\u0026ndash;694 (2009).\u003c/li\u003e\n\u003cli\u003eEckert, M. J. \u003cem\u003eet al.\u003c/em\u003e Bioprosthetic repair of complex duodenal injury in a porcine model. \u003cem\u003eJ Trauma\u003c/em\u003e \u003cstrong\u003e66\u003c/strong\u003e, 103\u0026ndash;109 (2009).\u003c/li\u003e\n\u003cli\u003eHosseini, S. V., Abbasi, H. R., Rezvani, H., Vasei, M. \u0026amp; Ashraf, M. J. Comparison between Gallbladder Serosal and Mucosal Patch in Duodenal Injuries Repair in Dogs. \u003cem\u003eJournal of Investigative Surgery\u003c/em\u003e \u003cstrong\u003e22\u003c/strong\u003e, 148\u0026ndash;153 (2009).\u003c/li\u003e\n\u003cli\u003eSimpson, M. \u0026amp; Hall, J. L. Transversus abdominis muscle as a gastric or intestinal on-lay flap in two dogs and one cat. \u003cem\u003eJ Small Anim Pract\u003c/em\u003e \u003cstrong\u003e62\u003c/strong\u003e, 918\u0026ndash;923 (2021).\u003c/li\u003e\n\u003cli\u003eKayaalp, C., Sumer, F., Polat, Y. \u0026amp; Kutlu, R. Autologous Peritoneum Graft Repair of a Superior Mesenteric Vein Defect During Pancreaticoduodenectomy. \u003cem\u003eCureus\u003c/em\u003e \u003cstrong\u003e7\u003c/strong\u003e, e340 (2015).\u003c/li\u003e\n\u003cli\u003eYoshioka, M. \u003cem\u003eet al.\u003c/em\u003e Reconstruction of the portal vein using a peritoneal patch-graft. \u003cem\u003eAm J Surg\u003c/em\u003e \u003cstrong\u003e181\u003c/strong\u003e, 247\u0026ndash;250 (2001).\u003c/li\u003e\n\u003cli\u003eWhitaker, D., Papadimitriou, J. M. \u0026amp; Walters, M. N. The mesothelium and its reactions: a review. \u003cem\u003eCrit Rev Toxicol\u003c/em\u003e \u003cstrong\u003e10\u003c/strong\u003e, 81\u0026ndash;144 (1982).\u003c/li\u003e\n\u003cli\u003eYin, W.-Y. Free Peritoneal Graft for Repair of Severe Seromuscular Defect of Bowel: From Experiment to Clinical Practice. \u003cem\u003eJournal of Surgical Research\u003c/em\u003e \u003cstrong\u003e125\u003c/strong\u003e, 3\u0026ndash;8 (2005).\u003c/li\u003e\n\u003cli\u003eBielecki, K., Kamiński, P. \u0026amp; Klukowski, M. Large bowel perforation: morbidity and mortality. \u003cem\u003eTech Coloproctol\u003c/em\u003e \u003cstrong\u003e6\u003c/strong\u003e, 177\u0026ndash;182 (2002).\u003c/li\u003e\n\u003cli\u003eCastillo, J. M. \u003cem\u003eet al.\u003c/em\u003e PARIETAL PERITONEUM GRAFT FOR DUODENUM INJURIES IN AN ANIMAL MODEL. \u003cem\u003eABCD, arq. bras. cir. dig.\u003c/em\u003e \u003cstrong\u003e32\u003c/strong\u003e, e1418 (2019).\u003c/li\u003e\n\u003cli\u003eMeurisse, N., Ansart, F., Honor\u0026eacute;, P. \u0026amp; De Roover, A. Glutaraldehyde-fixed parietal peritoneum graft conduit to replace completely the portal vein during pancreaticoduodenectomy: A case report. \u003cem\u003eInt J Surg Case Rep\u003c/em\u003e \u003cstrong\u003e74\u003c/strong\u003e, 296\u0026ndash;299 (2020).\u003c/li\u003e\n\u003cli\u003eCarrel, A. PERITONEAL PATCHING OF THE AORTA. \u003cem\u003eJ Exp Med\u003c/em\u003e \u003cstrong\u003e12\u003c/strong\u003e, 139\u0026ndash;145 (1910).\u003c/li\u003e\n\u003cli\u003eRadulova-Mauersberger, O. \u003cem\u003eet al.\u003c/em\u003e How we do it\u0026mdash;the use of peritoneal patches for reconstruction of vena cava inferior and portal vein in hepatopancreatobiliary surgery. \u003cem\u003eLangenbecks Arch Surg\u003c/em\u003e \u003cstrong\u003e407\u003c/strong\u003e, 3819\u0026ndash;3831 (2022).\u003c/li\u003e\n\u003cli\u003eLabori, K. J. \u003cem\u003eet al.\u003c/em\u003e Graft type for superior mesenteric and portal vein reconstruction in pancreatic surgery \u0026ndash; A systematic review. \u003cem\u003eHPB\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 483\u0026ndash;494 (2021).\u003c/li\u003e\n\u003cli\u003eOrda, R., Wiznitzer, T. \u0026amp; Nathan, H. Parietal-peritoneal patch for closure of intestinal perforations with butyl 2-cyanoacrylate monomer. \u003cem\u003eJournal of Surgical Research\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 315\u0026ndash;320 (1972).\u003c/li\u003e\n\u003cli\u003eRaffea, N. M. \u0026amp; Allawi, A. H. Effect of autologous peritoneum and platelet-rich fibrin graft on healing of intestinal anastomosis in dogs. \u003cem\u003eIraqi Journal of Veterinary Sciences\u003c/em\u003e \u003cstrong\u003e36\u003c/strong\u003e, 459\u0026ndash;470 (2022).\u003c/li\u003e\n\u003cli\u003eUema, R. T., Fazan, V. P. S., Cherri, J. \u0026amp; Piccinato, C. E. Bovine Peritoneum Protection Role on Intestinal Adhesions to a Vascular Graft: A Morphological Analysis. \u003cem\u003eInt. J. Morphol.\u003c/em\u003e \u003cstrong\u003e26\u003c/strong\u003e, (2008).\u003c/li\u003e\n\u003cli\u003eLaukka, M. \u003cem\u003eet al.\u003c/em\u003e Preperitoneal Fat Grafting Inhibits the Formation of Intra-abdominal Adhesions in Mice. \u003cem\u003eJ Gastrointest Surg\u003c/em\u003e \u003cstrong\u003e24\u003c/strong\u003e, 2838\u0026ndash;2848 (2020).\u003c/li\u003e\n\u003cli\u003eBresson, L., Leblanc, E., Lemaire, A. S., Okitsu, T. \u0026amp; Chai, F. Autologous peritoneal grafts permit rapid reperitonealization and prevent postoperative abdominal adhesions in an experimental rat study. \u003cem\u003eSurgery\u003c/em\u003e \u003cstrong\u003e162\u003c/strong\u003e, 863\u0026ndash;870 (2017).\u003c/li\u003e\n\u003cli\u003eWheeler, M. B. Patch Repair for Intestinal Perforation Closure in an Ex-Vivo Porcine Model with Burst Pressure Characterization. \u003cem\u003eJRMBR\u003c/em\u003e 1\u0026ndash;5 (2023) doi:10.46889/JRMBR.2023.4106.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"intestinal perforation, intestinal repair, parietal peritoneum, peritoneal patch","lastPublishedDoi":"10.21203/rs.3.rs-6986529/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6986529/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntestinal perforation is a surgical emergency associated with a significant morbidity and mortality. Current repair techniques such as primary suturing may be inefficient. The aim of this study was to evaluate the efficacy of autologous parietal peritoneal patch for the repair of small intestinal perforations. Twelve dogs were randomly assigned to two groups: Group A (n\u0026thinsp;=\u0026thinsp;6) underwent repair using a parietal peritoneal patch, while Group B (n\u0026thinsp;=\u0026thinsp;6) received conventional primary suturing. Animals were monitored clinically for 8 weeks. At endpoint, macroscopic and histological outcomes were assessed. All 12 dogs survived without major complications. The peritoneal patch group showed organized healing with neomucosal regeneration, minimal adhesions, and no stricture formation. In contrast, the control group showed more extensive adhesions, fibrosis, and stricture formation. Histological examination confirmed mature granulation tissue and epithelial coverage in Group A. Autologous parietal peritoneal patch offers a promising, biologically compatible technique for intestinal perforation repair. Compared to primary suturing, this approach reduced adhesions and enhanced tissue healing. Further studies are needed to validate its potential in gastrointestinal surgery.\u003c/p\u003e","manuscriptTitle":"Autologous Parietal Peritoneal Patch for Repair of Intestinal Perforations : An Experimental Study in a Canine Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:37:46","doi":"10.21203/rs.3.rs-6986529/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee613c3f-1dc1-47fa-8017-e85a6a7aa5b4","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-16T18:53:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-12 14:37:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6986529","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6986529","identity":"rs-6986529","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}