Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing.
OBJECTIVE
This study investigated whether covering the colonic anastomoses with amniotic membrane (AM) protects the anastomotic healing from the adverse effects of immediate 5-fluorouracil (5-FU) administration.


METHODS
One hundred twenty wistar albino rats were randomized to one of four groups (I-IV, 30 rats in each) and underwent a standardized left colon resection and anastomoses. The anastomoses of the rats in groups II (AM) and IV (5-FU + AM) were covered with AM. Saline solution (2 ml/day; groups I (control) and II) or 5-FU (20 mg/kg/day; groups III (5-FU) and IV) was administered to the rats intraperitoneally once daily from the day of operation until sacrificed. Half of each group was sacrificed on the postoperative day 4 (IA, IIA, IIIA, and IVA) and other half on the postoperative day 8 (IB, IIB, IIIB, and IVB), and their anastomoses were evaluated when sacrificed.


RESULTS
The dehiscence rate of anastomotic dehiscence and adhesion formation were significantly higher in groups IIIA and IIIB compared with groups IVA and IVB, respectively. Bursting pressure was significantly higher in the 5-FU + AM groups than in the 5-FU groups. The inflammatory cell infiltration was significantly lower in groups IIIA and IVA compared with group IA, in groups IIIB and IVB compared with group IB, and in group IVA compared with group IIIA. Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline levels were significantly higher in the 5FU + AM groups compared with control and 5-FU groups. Malondialdehyde levels were significantly higher in the 5-FU groups than in the 5-FU + AM groups.


CONCLUSIONS
Covering colon anastomoses with AM protects them, preventing leakage and reversing the negative effects of 5-FU administration.
Uludag
Mehmet
M
Second Department of General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey. drmuludag@hotmail.com
Ozdilli
Kursat
K
Citgez
Bulent
B
Yetkin
Gurkan
G
Ipcioglu
Osman M
OM
Ozcan
Omer
O
Polat
Nedim
N
Kartal
Abdulcabbar
A
Torun
Pinar
P
Isgor
Adnan
A
D000714:Anastomosis, Surgical; D000818:Animals; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000633:toxicity*; D001684:Biological Dressings; D001835:Body Weight; D003082:Colectomy / Q000009:adverse effects; D003106:Colon / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000633:toxicity*; D006909:Hydroxyproline / Q000378:metabolism; D007274:Injections, Intraperitoneal; D008315:Malondialdehyde / Q000378:metabolism; D018384:Oxidative Stress / Q000187:drug effects; D011312:Pressure; D051381:Rats; D017208:Rats, Wistar; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000473:pathology; D013997:Time Factors; D000267:Tissue Adhesions; D014945:Wound Healing / Q000187:drug effects*
D000964:Antimetabolites, Antineoplastic; D008315:Malondialdehyde; D006909:Hydroxyproline; D005472:Fluorouracil