title: Comparison of intestinal microcirculation and wound healing in a rat model.
abstract: OBJECTIVE
  If a colonic or small bowel lesion is not accessible for endoscopic mucosal resection, enterotomy is a possible although rarely performed surgical technique. It has never been compared to circular anastomosis regarding leakage rate, bowel wall perfusion, and wound healing. Thus, the aim of this basic experimental scientific study was to investigate perianastomotic microcirculation and wound healing.
  
  
  METHODS
  Forty rats were divided into four groups (1 jejunal anastomosis, 2 jejunal enterotomy, 3 colonic anastomosis, and 4 colonic enterotomy). Following anastomosis and enterotomy, the intestinal perfusion was measured using laser fluorescence angiography (IC-View). On postoperative day 7, the surface of the mucosal villi, expression of matrix metalloproteinases (MMP) 2, 8, 9, and 13, and the number of proliferating cells (Ki67) as well as the collagen types I/III ratio were analyzed.
  
  
  RESULTS
  The perianastomotic microperfusion was significantly reduced in all groups compared to the reference region. The perianastomotic perfusion index was significantly reduced in group 1 compared with group 2, whereas the perfusion index in group 3 was slightly but not significantly reduced in comparison to group 4. Ki67 was elevated in both circular anastomosis groups. Surface of the mucosal villi, MMP expression, and collagen type I/III ratio revealed no significant differences.
  
  
  CONCLUSIONS
  Our study affirms the theoretical consideration of a better microperfusion of the bowel wall following an antimesenterial enterotomy and demonstrates that enterotomy is not inferior compared to circular anastomosis. Even though enterotomy is a rarely used surgical technique, it should be regarded as a possible alternative in particular situations.
authors.affiliation: European Vascular Center Aachen Maastricht, RWTH Aachen University Hospital, Germany and Medical University Maastricht, Aachen, Netherlands. jgrommes@ukaachen.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Grommes
authors.forename: Marcel
authors.initials: M
authors.lastname: Binnebösel
authors.forename: Christian D
authors.initials: CD
authors.lastname: Klink
authors.forename: Klaus T
authors.initials: KT
authors.lastname: von Trotha
authors.forename: Karina
authors.initials: K
authors.lastname: Schleimer
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Jacobs
authors.forename: Ulf P
authors.initials: UP
authors.lastname: Neumann
authors.forename: Carsten J
authors.initials: CJ
authors.lastname: Krones
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak; D000818:Animals; D024042:Collagen Type I / Q000032:analysis; D024061:Collagen Type III / Q000032:analysis; D003106:Colon / Q000737:chemistry / Q000601:surgery* / Q000648:ultrastructure; D003125:Colostomy; D007413:Intestinal Mucosa / Q000648:ultrastructure; D007422:Intestines / Q000098:blood supply*; D007583:Jejunum / Q000737:chemistry / Q000601:surgery* / Q000648:ultrastructure; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D020782:Matrix Metalloproteinases / Q000032:analysis; D008833:Microcirculation; D008871:Microvilli / Q000648:ultrastructure; D051381:Rats; D013152:Splanchnic Circulation; D013536:Suture Techniques; D014945:Wound Healing
chemical_list: D024042:Collagen Type I; D024061:Collagen Type III; D019394:Ki-67 Antigen; D020782:Matrix Metalloproteinases