Effect of persistently elevated intraabdominal pressure on healing of colonic anastomoses.
BACKGROUND
The adverse effects of elevated intraabdominal pressure (IAP) on abdominal organs are realized, but its influence on anastomotic healing has not been studied. The aim of this study was to evaluate the effect of elevated IAP on healing of colonic anastomoses.


METHODS
Thirty rats, which all had right colonic anastomoses, were divided into five groups. Group 1 was the control group, and group 2 had fecal peritonitis. IAP was maintained between 4 to 6 mm Hg in group 3, 8 to 12 mm Hg in group 4, and 14 to 18 mm Hg in group 5 until all rats were sacrificed on day 4. Bursting pressures and tissue hydroxyproline concentrations of anastomoses were then analyzed and compared.


RESULTS
Mean +/- SEM of bursting pressures were 143+/-2.9 mm Hg in group 1, 72+/-14.4 mm Hg in group 2, 77.3+/-7.9 mm Hg in group 3, 57.5+/-11.2 mm Hg in group 4, and 40.1+/-9.6 mm Hg in group 5 (P<0.0001, one-way analysis of variance [ANOVA]). Mean +/- SEM of tissue hydroxyproline concentrations were 5.3+/-0.3 microg/mg in group 1, 4.7+/-0.5 microg/mg in group 2, 4.6+/-0.6 microg/mg in group 3, 3.6+/-0.5 microg/mg in group 4, and 2.4+/-0.2 microg/mg in group 5 (P = 0.0026, one-way ANOVA). The bursting pressure and hydroxyproline concentrations had good correlation (P<0.001, r = 0.76).


CONCLUSIONS
Elevated IAP delays healing of colonic anastomoses and 4 to 6 mm Hg IAP delays healing as much as fecal peritonitis. More elevated IAP delays healing more than fecal peritonitis. These events may be clinically important and may result from local-systemic effects of IAP.
Kologlu
M
M
Department of General Surgery, Hacettepe University Medical School, Ankara, Turkey.
Sayek
I
I
Kologlu
L B
LB
Onat
D
D
D000005:Abdomen / Q000502:physiology*; D000714:Anastomosis, Surgical; D000818:Animals; D003106:Colon / Q000601:surgery*; D005260:Female; D006909:Hydroxyproline / Q000032:analysis; D010538:Peritonitis / Q000503:physiopathology; D011184:Postoperative Period; D051381:Rats; D017208:Rats, Wistar; D014945:Wound Healing / Q000502:physiology*
D006909:Hydroxyproline