Fluorescein is comparable to methylene blue for intraoperative detection of intestinal leakage after enterotomy closure on porcine jejunal segments.

Objective: To compare the ease of visibility of lactated Ringer solutions with and without added dyes during leak testing of porcine cadaveric intestinal segments that underwent simple enterotomy.

Methods: 30 unpreserved jejunal segments were randomized into 1 of the 3 treatment groups as follows: lactated Ringer solution, fluorescein, and methylene blue. The preparation of tissues and experimentation was performed on September 17 and 18, 2024. Two-cm enterotomy incisions were made on the antimesenteric border and closed with a simple continuous suture pattern, leaving a 3-mm gap at the end of each closure. The randomly assigned solution was infused into each segment until leakage from the enterotomy gap was detected. Likert scores rating the ease of visibility of leakage detected by 1 of 2 observers, time to observed leakage, and volume infused were recorded.

Results: No statistical difference in Likert scores, time, or volume was detected among treatment groups. Observer results were independent of each other, and a high correlation between time and volume was demonstrated. A trend illustrating higher confidence and faster recognition in leak detection was noted for the fluorescein and methylene blue solutions compared to the nondyed lactated Ringer solution for both observers.

Conclusions: Ease of leakage identification and time to leak observation resulted in higher confidence and faster recognition with the use of a dyed solution compared to a nondyed solution.

Clinical relevance: The use of dyed solutions may facilitate the detection of intestinal leakage after enterotomy closure, and fluorescein is a comparable alternative to methylene blue for this purpose.