Effects of pneumoperitoneum with or without colostomy on rat colonic anastomotic healing.
BACKGROUND
Elevated intra-abdominal pressure and colostomy have adverse effects on colonic anastomoses. The aim of the present study was to investigate the effects of laparoscopic colon surgery with and without diverting colostomy on healing of colonic anastomoses in an experimental model.


METHODS
Thirty-six male rats were divided into three equal groups: group 1, control (colonic anastomosis and anaesthesia for 180 min only); group 2, 180 min pneumoperitoneum and colonic anastomosis; and group 3, similar to group 2 with a proximal colostomy. On day 7, bursting pressures, tissue hydroxyproline and nitric oxide concentrations and histopathological inflammation scores were determined and compared.


RESULTS
Mean bursting pressures were higher in the control group than the two pneumoperitoneum groups (P=0.0003). Mean tissue hydroxyproline concentrations showed no difference (P>0.05). Mean tissue nitric oxide concentrations were significantly increased in the control group (P=0.0013). Histopathological scores demonstrated increased inflammatory response in group 3 compared to the controls (P=0.0009).


CONCLUSIONS
Pneumoperitoneum delays collagen maturation and impairs anastomotic strength in the colon. Following pneumoperitoneum, performance of a diverting loop colostomy to protect the anastomosis will not have additional detrimental effects on anastomotic healing.
Ozgün
Hedef
H
Faculty of Medicine, Department of Surgery, Adnan Menderes University, Aydin, Turkey. hedefozgun@yahoo.com
Boylu
Sükrü
S
Cevikel
Mehmet H
MH
Yenisey
Cigdem
C
Erpek
Hakan
H
Culhaci
Nil
N
Demirkiran
Ahmet E
AE
D000714:Anastomosis, Surgical; D000818:Animals; D003106:Colon / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D003125:Colostomy; D006909:Hydroxyproline / Q000378:metabolism; D010535:Laparoscopy; D008297:Male; D023421:Models, Animal; D009569:Nitric Oxide / Q000378:metabolism; D011028:Pneumoperitoneum, Artificial; D051381:Rats; D017208:Rats, Wistar; D013718:Tensile Strength; D014945:Wound Healing
D009569:Nitric Oxide; D006909:Hydroxyproline