title: Intraoperative crystalloid overload leads to substantial inflammatory infiltration of intestinal anastomoses-a histomorphological analysis.
abstract: BACKGROUND
  It has been shown that crystalloid fluid-overload promotes anastomotic instability. As physiologic anastomotic healing requires the sequential infiltration of different cells, we hypothesized this to be altered by liberal fluid regimes and performed a histomorphological analysis.
  
  
  METHODS
  36 Wistar rats were randomized into 4 groups (n=8-10 rats/group) and treated with either liberal (+) or restrictive (-) perioperative crystalline (Jonosteril = Cry) or colloidal fluid (Voluven = Col). Anastomotic samples were obtained on postoperative day 4, routinely stained and histophathologically reviewed. Anastomotic healing was assessed using a semiquantitative score, assessing inflammatory cells, anastomotic repair and collagenase activity.
  
  
  RESULTS
  Overall, the crystalloid overload group (Cry (+)) showed the worst healing score (P < 0.01). A substantial increase of lymphocytes and macrophages was found in this group compared to the other three (P < 0.01). Both groups that received colloidal fluid (Col (+) and Col (-)) as well as the group that received restricted crystalloid fluid resuscitation (Cry (-)) had better intestinal healing. Collagenase activity was significantly higher in the Cry (+) group.
  
  
  CONCLUSIONS
  Intraoperative infusion of high-volume crystalloid fluid leads to a pathological anastomotic inflammatory response with a marked infiltration of leukocytes and macrophages resulting in accelerated collagenolysis.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany. birte.kulemann@uniklinik-freiburg.de
authors.forename: Birte
authors.initials: B
authors.lastname: Kulemann
authors.forename: Sylvia
authors.initials: S
authors.lastname: Timme
authors.forename: Gabriel
authors.initials: G
authors.lastname: Seifert
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Holzner
authors.forename: Torben
authors.initials: T
authors.lastname: Glatz
authors.forename: Olivia
authors.initials: O
authors.lastname: Sick
authors.forename: Sophia
authors.initials: S
authors.lastname: Chikhladze
authors.forename: Peter
authors.initials: P
authors.lastname: Bronsert
authors.forename: Jens
authors.initials: J
authors.lastname: Hoeppner
authors.forename: Martin
authors.initials: M
authors.lastname: Werner
authors.forename: Ulrich T
authors.initials: UT
authors.lastname: Hopt
authors.forename: Goran
authors.initials: G
authors.lastname: Marjanovic
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D003094:Collagen / Q000032:analysis; D000077324:Crystalloid Solutions; D007150:Immunohistochemistry; D007249:Inflammation / Q000473:pathology*; D007422:Intestines / Q000473:pathology / Q000601:surgery*; D007552:Isotonic Solutions / Q000008:administration & dosage*; D007962:Leukocytes / Q000502:physiology; D008264:Macrophages / Q000502:physiology; D008297:Male; D053509:Matrix Metalloproteinase 13 / Q000032:analysis; D020778:Matrix Metalloproteinase 2 / Q000032:analysis; D051381:Rats; D017208:Rats, Wistar; D014945:Wound Healing
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D003094:Collagen; D053509:Matrix Metalloproteinase 13; D020778:Matrix Metalloproteinase 2