title: A new anastomotic leakage model in circular double stapled colorectal anastomosis after low anterior rectum resection in pigs.
abstract: BACKGROUND
  A high incidence of anastomotic leakage (37.5%) is reported after low anterior rectal resection (LAR) and circular double-stapled anastomosis without protective ileostoma. Since the pathomechanism of anastomosis leakage is still unclear, a suitable animal model would be most desirable.
  
  
  METHODS
  The objective was to assess the incidence of clinically apparent and inapparent leakage after LAR in pigs (n = 20). Endpoints were radiological, clinical, macroscopic, and histologic proof of anastomotic leakage on the 9th postoperative day. Integrity of anastomosis was assessed by double-contrast barium examination on 9th postoperative day. Animals were sacrificed and anastomoses were resected for histopathological investigation. In case of earlier clinical apparent anastomotic leakage, radiologic double-contrast barium was performed immediately.
  
  
  RESULTS
  LAR with a circular double-stapled anastomosis without protective ileostoma was performed in 20 pigs (m:f = 8:12). Length of resection was 10-20 cm, anastomosis was performed 7 cm ab ano. Five animals (25%) developed clinical apparent anastomotic leakage (no appetite, fever, inactivity, tachypnea, discomfort, pain) between the 6th (n = 1) and 9th (n = 4) postoperative day, proven by double-contrast barium radiographs. Additionally in 1 animal clinical inapparent anastomotic insufficiency was observed radiologically. Total rate of leakage was 30% (n = 6). These results were confirmed by leucocytosis, low potassium levels, in two cases high ALT and AST and local peritonitis in all cases.
  
  
  CONCLUSIONS
  Including one additional case of clinical inapparent leakage, total rate of anastomotic leakage was 30% (6/20). Thus we managed to establish a new experimental model of anastomotic leakage after low rectal resection comparable to the human situation.
authors: 1 Clinic of General, Visceral and Thoracic Surgery, Asklepios Südpfalzklinik Kandel, Kandel, Germany.
authors: F A
authors: FA
authors: Wenger
authors: E
authors: E
authors: Szucsik
authors: B F
authors: BF
authors: Hoinoiu
authors: M
authors: M
authors: Ionac
authors: M K
authors: MK
authors: Walz
authors: K W
authors: KW
authors: Schmid
authors: H
authors: H
authors: Reis
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods / Q000662:veterinary; D057868:Anastomotic Leak / Q000209:etiology* / Q000473:pathology; D000818:Animals; D003106:Colon / Q000000981:diagnostic imaging; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000662:veterinary*; D005260:Female; D008297:Male; D023421:Models, Animal; D010538:Peritonitis / Q000209:etiology / Q000473:pathology; D011859:Radiography; D012007:Rectum / Q000601:surgery*; D013552:Swine / Q000601:surgery*