Effect of Intraoperative Nutritional Solutions on Perianastomotic Colonic Mucosa in Experimental Large Bowel Obstruction

Abstract

We investigated the effect of intraoperativelavage with various solutions on the morphology of themucosa adjacent to the anastomosis performed inleft-sided colonic obstruction. After 24 hr of ligature obstruction to the pelvic colon, 108 maleWistar rats underwent colonic resection followed byprimary anastomosis and were randomized for lavage withone of four different solutions: saline,povidone-iodine, 10% hypertonic glucose (HG), and short-chainfatty acids (SCFA). A control group had no lavage. Theanastomotic region was studied both macroscopically andwith light microscopy after three or six days. At day 3, lavaged animals, especially thosewith SCFA, had significantly smaller ulcers thancontrols, and at day 6 only rats lavaged with SCFA andHG were free of large ulcers. At day 3, median(interquartile range) crypt depth was higher in SCFA [360(286-374) μm] and HG animals [306 (279-315) μm]when compared with controls [243 (225-252) μm; P <0.05], and SCFA [67 (53-89)] rats showed more cells per crypt than controls [48 (39-52); P <0.05]. No differences occurred on the sixth day. Weconclude that intraoperative lavage with nutrientsolutions, particularly with SCFA, has a trophic effecton the colonic mucosa. The suture line gap in themucosa may be filled more quickly, thus contributing toimprove the healing of a colonic anastomosis.