Impact of intraoperative temperature and humidity on healing of intestinal anastomoses.
OBJECTIVE
Clinical data indicate that laparoscopic surgery has a beneficial effect on intestinal wound healing and is associated with a lower incidence of anastomotic leakage. This observation is based on weak evidence, and little is known about the impact of intraoperative parameters during laparoscopic surgery, e.g., temperature and humidity.


METHODS
A small-bowel anastomosis was formed in rats inside an incubator, in an environment of stable humidity and temperature. Three groups of ten Wistar rats were operated: a control group (G1) in an open surgical environment and two groups (G2 and G3) in the incubator at a humidity of 60 % and a temperature of 30 and 37 °C (G2 and G3, respectively). After 4 days, bursting pressure and hydroxyproline concentration of the anastomosis were analyzed. The tissue was histologically examined. Serum levels of C-reactive-protein (CRP) were measured.


RESULTS
No significant changes were seen in the evaluation of anastomotic stability. Bursting pressure was very similar among the groups. Hydroxyproline concentration in G3 (36.3 μg/g) was lower by trend (p = 0.072) than in G1 (51.7 μg/g) and G2 (46.4 μg/g). The histological evaluation showed similar results regarding necrosis, inflammatory cells, edema, and epithelization for all groups. G3 (2.56) showed a distinctly worse score for submucosal bridging (p = 0.061) than G1 (1.68). A highly significant increase (p = 0.008) in CRP was detected in G3 (598.96 ng/ml) compared to G1 (439.49 ng/ml) and G2 (460 ng/ml).


CONCLUSIONS
A combination of high temperature and humidity during surgery induces an increased systemic inflammatory response and seems to be attenuating the early regeneration process in the anastomotic tissue.
Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Hugstetterstrasse 55, Freiburg, 79106, Germany, Torben.Glatz@gmx.de.
Torben
T
Glatz
Johannes
J
Boldt
Sylvia
S
Timme
Birte
B
Kulemann
Gabriel
G
Seifert
Philipp Anton
PA
Holzner
Sophia
S
Chikhladze
Jodok Matthias
JM
Grüneberger
Simon
S
Küsters
Olivia
O
Sick
Jens
J
Höppner
Ulrich Theodor
UT
Hopt
Goran
G
Marjanovic
D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D000818:Animals; D002097:C-Reactive Protein / Q000378:metabolism; D006813:Humidity; D006909:Hydroxyproline / Q000378:metabolism; D007422:Intestines / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007432:Intraoperative Period; D008297:Male; D017208:Rats, Wistar; D013696:Temperature; D013718:Tensile Strength; D000267:Tissue Adhesions / Q000473:pathology; D014945:Wound Healing / Q000502:physiology*
D002097:C-Reactive Protein; D006909:Hydroxyproline