Untersuchung zur Fr�hphase der Anastomosenheilung unter besonderer Ber�cksichtigung von Peritonitis und Isch�mie

Abstract

Experimental sutureless colonic anastomosis was evaluated under various conditions during the first 24 postoperative hours. Adaptation of large bowel segments was achieved by interrupted inverting sutures, which were removed after one hour. This short adaptation period was sufficient for fibrinous contact of bowel segments. Breaking strength of intestinal anastomosis was determined under normal conditions, in peritonitis, complete ischemia and unilateral ischemia of one bowel segment. As control parameter breaking strength of conventional anastomosis was determined under normal conditions. We obtained the following results: 1) Sutureless anastomosis exhibited significantly lower breaking strength than conventional anastomosis. 2) Sutureless anastomosis showed a significant increase in breaking strength under normal conditions after the first 6 h, on the contrary breaking strength remained at lower levels in peritonitis. 3) In complete ischemia anastomotic failure was observed even after 3 h of adaptation. Therefore breaking strength was not measurable. 4) Under unilateral ischemia breaking strength of intestinal anastomosis was significantly lower than under normal conditions.

Effect of Fibrin Sealant on Anastomotic Healing in Peritonitis and Ischemia

“…In the first 3 days of anastomotic healing, breaking strength is a more reliable parameter for assessment of the mechanical load of anastomosis compared to burst ing pressure [2,4], In peritonitis or ischemia, breaking strength of SLA is significantly decreased, probably due to disturbances of Fibrin exsudation and stabilization [2] (compare SLA in fig. 1 and 2).…”

“…Breaking strength was determined after relaparotomy of ani mals 6, 12, 24 and 48 h after removal of temporary sutures with a tensiometer (speed: 1 mm/s, as described previously [2], The co lonic segment was fixed to a tensiometer with two clips which were placed 1 cm oral and aboral of the anastomosis. The anastomosis was torn apart with a defined speed of I mm/s.…”

“…The early phase of anastomotic healing is predom inantly a phase of fibrin exsudation and stabilization. In order to study the fibrinous phase of anastomotic healing not disturbed by suture material, we established an experimental model of sutureless colonic anastomosis (SLA) [1], Under normal conditions, a 1-hour period of temporary adaptation is sufficient to stabilize the anas tomosis as assessed by breaking strength and bursting pressure [1,2]. In peritonitis or ischemia, a significant decrease of breaking strength can be observed [2].…”

“…In order to study the fibrinous phase of anastomotic healing not disturbed by suture material, we established an experimental model of sutureless colonic anastomosis (SLA) [1], Under normal conditions, a 1-hour period of temporary adaptation is sufficient to stabilize the anas tomosis as assessed by breaking strength and bursting pressure [1,2]. In peritonitis or ischemia, a significant decrease of breaking strength can be observed [2]. The present study was performed in order to evaluate whether application of fibrin sealant can compensate for defective spontaneous fibrin exsudation in peritonitis and ischemia, thus resulting in an increase of mechanical strength of bowel anastomosis.…”

Effects of Local Ischemia and Bacterial Flora on Healing of Experimental Colonic Anastomoses

“…In previous animal studies under ischemic conditions [2], we were able to demonstrate a defective early phase of anastomotic healing. This was attributed to a reduced fibrin exsudation as a consequence of reduced bowel per-fusion.…”