2001, Number 2
PDF size: 48.07 Kb.
ABSTRACTObjective: To determine frequency of dehiscences of the colonic anastomosis in the rat, an experimental model.
Setting: Third level health care hospital.
Design: Experimental, prospective, comparative study. Material and methods: Thirty-eight Wistar rats, approximately 1 year of age, were used. Rats were assigned to two groups. Group A (undernourished) and Group B (well-nourished). Group A was subjected to a hypocaloric diet (18 kcal/day) for one week to induce a 20% weight loss. Group B received a 72 kcal/day diet for the same period of time. In both groups, we quantified: weight, albumin, and total lymphocytes. All rats were operated. Under general anesthesia, 1 cm of the left colon was resected, placing a ligature on the marginal artery and performing anastomosis in a single plane using 6-0 polypropylene with interrupted plain stitches.
Statistical analysis: Descriptive statistics was used for independent variables, Chi square and exact Fisher’s tests for nominal variables, and Student’s t test for quantitative variables. Null hypothesis was rejected at an alpha value minor than 0.05, at a significance level of 90% (We used Word 2000, EPIINFO, Version 5).
Results: Nutritional parameters: In group A, a weight loss of 25% was observed (initial weight 466 g, final weight 347 g); p › 0.05. Albumin decreased from 1.61 (SD ± 0.16) to 1.17 (SD ± 0.20); p › 0.05. Lymphocytes decreased from 11,119 (SD ± 3,263) to 3,235 (SD ± 2,130) with p › 0.05. In group B, the initial weight was 505 g (SD ± 66) and the final weight was 506 g (SD ± 62); initial albumin increased from 1.65 (SD ± 0.27) to 3.58 (SD ± 0.21), and the lymphocytes count increased from 9,261 (SD ± 4,406) to 10,065 (SD ± 4,468). Surgical findings: In group A, from 19 rats, 9 presented dehiscence of the anastomosis, 9 died, and 2 presented pericolonic abscesses, only in eight was the anastomosis uneventful. In group B, only 5 rats developed adherences around the anastomosis, no deaths occurred.
Conclusion: The nutritional state affects colonic cicatrization, induces immunodepression, fostering development of abscesses.
Ward MWN, Danzi M, Lawin MR, J, Clark CG. The effects of subclinical malnutrition and refeeding on the healing of experimental colonic anastomoses. Br J Surg 1982; 69: 308–10.
Thornton FJ, Barbul A. Healing in the gastrointestinal tract. Surg Clin North Am 1997; 77: 549–73.
Golub R, Golub RW, Cantu R Jr, Stein HD. A multivariate analysis of factors contributing to leakage of intestinal anastomoses. J Am Coll Surg 1997; 184: 364–72
Tadros T, Wobbes T, Hendriks T. Opposite effects of interleukin–2 on normal and transfusion–suppressed healing of experimental intestinal anastomoses. Ann Surg 1993; 218: 800–8.
Tadros T, Wobbes T, Hendriks T. Blood transfusion impairs the healing of experimental intestinal anastomoses. Ann Surg 1992; 215: 276–81.
Chung RS. Blood flow in colonic anastomoses. Effect of stapling and suturing. Ann Surg 1987; 206: 335–9.
Jonsson K, Jiborn H, Zederfeldt B. Collagen metabolism in small intestinal anastomosis. Am J Surg 1987; 154: 288–91.
Roediger WE. Utilization of nutrients by isolated epithelial cells of rat colon. Gastroenterology 1982; 83: 424–9.
Kripke SA, Fox AD, Bermen JM, Settle RG, Rombeau JL. Stimulation of intestinal mucosal growth with intracolonic infusion of short–chain fatty acids. J Parenter Enteral Nutr 1989; 12: 109–16.
Delany HM, Demetriou AA, Teh E, Levenson SM. Effect of early postoperative nutritional support on skin wound and colon anastomoses healing. J Parenter Enteral Nutr 1990; 14: 357–61.
Alberdy J, Chi HS, Sheldon GF. The effect of parenteral nutrition on gastrointestinal immunity. Ann Surg 1985; 202: 681–4.
McCauley R, Platell C, Hall J, McCulloch R. Effects of glutamine infusion on colonic anastomotic strength in the rat. J Parenter Enteral Nutr 1991; 15: 437–9.
Bower RH. Nutrition and immune function. Nutr Clin Pract 1990; 5: 189–95.
Kinsella JE, Lockesh B. Dietary lipids, eicosanoids, and the immune system. Crit Care Med 1990; 18(Supp 2): S94–S113.
Waninger J, Kauffmann GW, Shah IA, Farhmann EH. Influence of the distance between interrupted sutures and the tension of sutures on the healing of experimental colonic anastomoses. Am J Surg 1992; 163: 319–22.
Cummings JH. Dietary fibre. Br Med Bull 1981; 37: 65–70.