The prevention of leakage of ileo-colonic anastomosis in an experimental peritonitis

Abstract

Introduction. In colon surgery, intestinal anastomotic leaks are the main contributor to postoperative mortality. The incidence of this complication in the formation of small-colonic anastomoses in urgent surgery reaches 12% or more. It is required to develop simple and reliable techniques of intestinal suturing in conditions of peritonitis.The aim of the study was to investigate the morphological events occurring in the small-colonic anastomosis formed using various options under simulated peritonitis.Materials and methods. An experimental study involved 2 groups of Wistar white rats (25 animals - the control group and 25 - the main one). Peritonitis was simulated by dissecting the ileum into circles in 5-6 cm from the ileocecal angle. A day later, a relaparotomy was performed, a section of the intestine with a defect was excised, the distal loop was tied up, a small-colonic anastomosis was formed with a proximal loop: in the end-to-side study group the intervention was performed according to the author's method (RF patent No. 2709253 dated 12/17/2019), in the control group using side-to-side anastomosis. In 6 days, anastomosis was taken from the survived animals for histological examination. Histological examination was carried out at a magnification x400 and x630. Micromorphometry was performed with the count of neutrophils, fibroblasts and measurement of the relative area of ​​blood vessels in the anastomotic suture. Fisher's exact test, Mann-Whitney test were used for statistical data processing, quantitative data were described in the median and interquartile interval format.Results. An original end-to-side anastomosis resulted in a greater number of fibroblasts and blood vessels in the muscular and submucosal layers of the intestinal wall in the suture zone than in the side-to-side anastomosis. The number of anastomotic leaks in the study group was 4 times less than in the control group.Conclusion. The use of the authors end-to-side anastomosis technique improves blood supply and repair of the suture area in a small-colonic anastomosis under 1-day simulated peritonitis; this being accompanied by a decreased incidence of anastomosis failure.