Morphological evaluation of the different methods used for protection of colonic anastomosis

Abstract

Introduction: Despite the performances of modern medicine, especially of colorectal surgery, anastomotic leakage remains one of the most dangerous postoperative complications, without significant trend of decreasing. Morbidity and mortality increase considerably after the development of an anastomotic leakage. Anastomotic leakage presents an important problem of public health with major socio-economic impact and can be considered one of the quality indicators of specialized surgical centers' activity. There are multiple studies running in order to create and assess the efficacy of colonic anastomosis local protection methods. Aim of study was morphological evaluation of the methods used for local protection of anastomotic zone and their influence on the anastomosis healing. Materials and methods: Sixty three rats were divided in three groups: colonic anastomosis was performed and topical latex tissue adhesive was applied in the group I (n=21); colonic anastomosis with local application of collagen patch in the group II; colonic anastomosis without local protection in the group III. Results: Anastomotic leakage was not determined in the group I vs the group III, where were detected 5 cases of anastomotic leakage. According to the present study’s data in the group I was determined early diminution exudativ-detersiv process’ activity vs groups II and III (p<0.01). Latex tissue adhesive has positive influence on the processes of neoangiogenesis and fibrilogenesis in the anastomotic zone on the 14th POD vs the group II and III (p<0.05). According to ours data latex tissue adhesive has considerable compatibility with colonic tissue that represents the absence of giant like „foreign bodies” symplasts and insignificant immunologic reaction of large bowel. Aggressive bacterial colonization in this group has contributed for appearance of anastomotic leakage, formation of abscesses and granulomatous processes like „foreign bodies”. Mentioned processes considerable have complicated synchronous evolution of neoangiogenesis and fibrilogenesis in the anastomotic zone, resulted in decreasing of the primary healing, appearance of anastomotic deformations and expression of the adhesion process vs anastomosis from the groups I and III. Conclusion: Using of latex tissue adhesive for local protection of colonic anastomosis improves anastomotic healing, processes of neoangiogenesis and fibrilogenesis. Using of collagen patch for local protection of colonic anastomosis doesn’t have any advantages and provokes delaying of regeneratory processes and persisting of an inflammatory process.