Berstungsdruck, Expressionsverhalten von MMP 13 und VEGF von genähten, teilgeklebten und komplett geklebten kolorektalen Anastomosen im septischen Rattenmodell

Abstract

Insufficiency rates up to 25 % and an associated mortality up to 50 % clearly illustrate the problem of colorectal anastomoses. Primary protection of the anastomosis by use of a glue-on collagen fleece may influence the rate of insufficiencies and the deleterious course. The aim of this study was to compare sutured and glued anastomoses in a rat peritonitis model. The target parameters were the anastomotic bursting pressure, expression of MMP 13 and VEGF. Methods: Fecal peritonitis was induced in 90 male Wistar rats by inoculation of human feces. Animals were randomized in 3 groups (I: circular sutured anastomosis at the rectosigmoid junction; II: semicircular sutured anastomosis and closure of the anterior wall with fibrin-coated collagen fleece (Tachosil^R); III: complete gluing of the anastomosis with fibrin-coated collagen fleece (Tachosil^R)). Five animals were evaluated at each examination point. The bursting pressure was measured after 24, 72 and 120 hours. Anastomotic tissue was tested for the expression of MMP 13 and VEGF by Real-Time-PCR. Results: Bursting pressure was comparable in all 3 groups. MMP 13 expression was significantly reduced in group III (complete gluing) after 72 and 120 hours, whereas expression of VEGF was increased in the gluing groups (II and III) at all three time points. Conclusion: Bursting pressures indicate a comparable stability of the anastomoses in all three groups. Glue-on collagen fleece may promote anastomotic healing by increased VEGF expression and reduced remodeling (MMP 13) activity.