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Healing of ischemic colonic anastomosis: Fibrin sealant does not improve wound healing

  • Original Contributions
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Diseases of the Colon & Rectum

Abstract

Fibrin adhesives have been advocated as a protective sealant in high-risk colonic anastomoses to prevent leakage. To assess the effect of fibrin glue sealing on the healing ischemic anastomosis, we compared the healing of sutured colonic anastomoses in the rat, with and without fibrin adhesive (Groups IA and IB), and ischemic anastomoses with and without fibrin adhesive (Groups IIA and IIB). On days two, four, and seven, 10 animals in each group were sacrificed. Adhesion formation was scored, and thein situbursting pressure was measured. The collagen concentration and degradation were estimated by measuring hydroxyproline. Adhesion formation was more prominent in Groups IB, IIA, and IIB on day four only; abscesses were noted in the ischemic group in four rats. Anastomotic bursting pressure was significantly lower in sealed (IB) and ischemic anastomoses (IIA) than in normal anastomoses (IA) on day four. Sealing of ischemic anastomoses did not change bursting pressures on days two, four, and seven. The relative decrease of collagen in the sealed anastomoses is significantly higher on day four only. It is concluded that sealing of normal colonic anastomoses in the rat has a negative effect on wound healing. Ischemia at the anastomotic site results in weaker anastomotic strength on day four postoperatively. Also in ischemic anastomoses, fibrin sealant does not improve wound healing during the first seven days. Adhesion formation on ischemic intestinal anastomoses was not prevented by fibrin sealing.

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References

  1. Goligher JC, Graham NG, De Dombal FT. Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg 1970;57:109–18.

    PubMed  CAS  Google Scholar 

  2. Fielding LP, Stewart-Brown S, Blesovsky L, Kearny G. Anastomotic integrity after operations for large-bowel cancer: a multicentre study. BMJ 1980;281:411–4.

    Article  PubMed  CAS  Google Scholar 

  3. Shandall A, Lowndes R, Young HL. Colonic anastomotic healing and oxygen tension. Br J Surg 1985;72:606–9.

    PubMed  CAS  Google Scholar 

  4. Hunt TK, Pai MP. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 1972;135:561–7.

    PubMed  CAS  Google Scholar 

  5. Foster ME, Lancaster J, Leaper DJ. Leakage of low rectal anastomoses—an anatomic explanation. Dis Colon Rectum 1984;27:157–8.

    PubMed  CAS  Google Scholar 

  6. Schrock TR, Deveney CW, Dunphy JE. Factors contributing to leakage of colonic anastomoses. Ann Surg 1973;127:513–8.

    Article  Google Scholar 

  7. Tagart RE. Colorectal anastomosis: factors influencing success. J R Soc Med 1981;74:111–8.

    PubMed  CAS  Google Scholar 

  8. Banerjee SK, Glynn LE. Reactions to homologous and heterologous fibrin implants in experimental animals. Ann N Y Acad Sci 1960;86:1054–7.

    Google Scholar 

  9. Leibovich SJ, Ross R. A macrophage-dependent factor that stimulates the proliferation of fibroblasts in vitro. Am J Pathol 1976;84:501–3.

    PubMed  CAS  Google Scholar 

  10. Phol J, Brunn HD, Christophers E. Thrombin and fibrin-induced growth of fibroblasts: role in wound repair and thrombus organization. Klin Wochenschr 1979;57:273–7.

    Article  PubMed  Google Scholar 

  11. Petrelli NJ, Cohen HC, DeRisi D,et al. The application of tissue adhesives in small-bowel anastomoses. J Surg Oncol 1982;19:59–61.

    PubMed  CAS  Google Scholar 

  12. Scheele J, Herzog J, Mühe E. Fibrin glue protection of digestive anastomoses. Zentralbl Chir 1978;103:1325–36.

    PubMed  CAS  Google Scholar 

  13. Pointner R, Villinger R. Vorbeugung der intraperitonealen Nahtinsuffizienz durch Einsatz von Fibrin kleber. Zentralbl Chir 1984;109:1146–48.

    PubMed  CAS  Google Scholar 

  14. Athanasiadis S, Kuhlgatz Ch, Girona I. Additional fibrin glueing in surgery of colon and rectum. Zentralbl Chir 1984;109:1107–11.

    PubMed  CAS  Google Scholar 

  15. Waclawiczek HW, Boeckl O. Clinical experience from fibrin sealing in general and thoracic surgery. Zentralbl Chir 1986;111:16–24.

    PubMed  CAS  Google Scholar 

  16. Giardino R, Brulatti M, Franchini A. Colonic anastomoses protected with fibrin sealant. In: Schlag G, Redl H, eds: Fibrin sealant in operative medicine. General surgery and abdominal surgery. Vol. 6. Heidelberg: Springer-Verlag, 1986:155–8.

    Google Scholar 

  17. Nordkild P, Hjortrup A, Kjægaard J. Tissue adhesives and intestinal anastomosis. Ann Chir Gynaecol 1986;75:205–8.

    PubMed  CAS  Google Scholar 

  18. Houston KA, Rotstein OD. Fibrin sealant in high-risk anastomoses. Arch Surg 1988;123:230–4.

    PubMed  CAS  Google Scholar 

  19. Hulkko OA, Haukipuro KA, Laitinen ST. Fibrin glue protection of primary anastomosis in the obstructed left colon; an experimental study on the rat. Acta Chir Scand 1988;154:49–52.

    PubMed  CAS  Google Scholar 

  20. van der Ham AC, Kort WJ, Weijma IM, Van den Ingh HF, Jeekel J. The effect of fibrin sealant on the healng colonic anastomosis in the rat. Br J Surg 1991;78:49–53.

    PubMed  Google Scholar 

  21. Foster ME, Brennan SS, Morgan A, Leaper DJ. CoIonic ischaemia and anastomotic healing. Eur Surg Res 1985;17:133–9.

    PubMed  CAS  Google Scholar 

  22. Kirk D, Irvin TT. The role of oxygen therapy in the healing of experimental skin wounds and colonic anastomosis. Br J Surg 1977;64:100–3.

    PubMed  CAS  Google Scholar 

  23. Cohen SR, Cornell CN, Collins MH, Sell JE, Blanc WA, Altman RP. Healing of ischemic colonic anastomoses in the rat: role of antibiotic preparation. Surgery 1985;97:443–6.

    PubMed  CAS  Google Scholar 

  24. Stegemann H, Stalder K. Determination of hydroxyproline. Clin Chim Acta 1967;18:267–73.

    Article  PubMed  CAS  Google Scholar 

  25. Grant RA. Estimation of hydroxyproline by the AutoAnalyser. J Clin Pathol 1964;17:685–6.

    PubMed  CAS  Google Scholar 

  26. Kirk D, Irvin TT. The role of oxygen therapy in the healing of experimental skin wounds and colonic anastomoses. Br J Surg 1977;64:100–3.

    PubMed  CAS  Google Scholar 

  27. Gottrup F. Healing of incisional wounds in stomach and duodenum: collagen distribution and relation to mechanical strength. Am J Surg 1981;141:222–7.

    PubMed  CAS  Google Scholar 

  28. Wise L, McAlister W, Stein T, Schuck P. Studies on the healing of anastomoses of small and large intestines. Surg Gynecol Obstet 1975;141:190–4.

    PubMed  CAS  Google Scholar 

  29. Jiborn H, Ahonen J, Zederfeldt B. Healing of experimental colonic anastomoses: III. Collagen metabolism in the colon after left colon resection. Am J Surg 1980;139:398–405.

    Article  PubMed  CAS  Google Scholar 

  30. Cronin K, Jackson DS, Dunphy JE. Changing bursting strength and collagen content of the healing colon. Surg Gynecol Obstet 1968;126:747–53.

    PubMed  CAS  Google Scholar 

  31. Hawley PR. Causes and prevention of colonic anastomotic breakdown. Dis Colon Rectum 1973;16:272–7.

    PubMed  CAS  Google Scholar 

  32. Hawley PR, Faulk WP, Hunt TK, Dunphy JE. Collagenase activity in the gastrointestinal tract. Br J Surg 1970;170:896–900.

    Google Scholar 

  33. Ellis H. The cause and prevention of postoperative intraperitoneal adhesions. Surg Gynecol Obstet 1971;133:407–511.

    Google Scholar 

  34. Brands W, Jung M, Manegold C, Liedgens P, König M, Stock M. Prophylaxis and therapy of intra-abdominal adhesions with highly concentrated human fibrinogen: experimental and clinical results. In: Waclawiczek HW, ed. Progress in fibrin sealing. Heidelberg: Springer-Verlag, 1989:141–5.

    Google Scholar 

  35. Lindenberg S, Steentoft P, Sørensen SS, Olesen HP. Studies on prevention of intra-abdominal adhesion formation by fibrin sealant: an experimental study in rats. Acta Chir Scand 1985;151:525–7.

    PubMed  CAS  Google Scholar 

  36. DeVirgillio C, Dubrow T, Sheppard BB,et al. Fibrin glue inhibits intra-abdominal adhesion formation. Arch Surg 1990;125:1378–82.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Laboratory for Experimental Surgery, Erasmus University, Rotterdam

    Arie C. van der Ham M.D., Wil J. Kort Ph.D., Ineke M. Weijma B.S. & Hans Jeekel M.D, Ph.D.

  2. Department of Pathology, St. Clara Ziekenhuis, Rotterdam, The Netherlands

    Harry F. G. M. van den Ingh M.D., Ph.D.

Authors
  1. Arie C. van der Ham M.D.
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  2. Wil J. Kort Ph.D.
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  3. Ineke M. Weijma B.S.
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  4. Harry F. G. M. van den Ingh M.D., Ph.D.
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  5. Hans Jeekel M.D, Ph.D.
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van der Ham, A.C., Kort, W.J., Weijma, I.M. et al. Healing of ischemic colonic anastomosis: Fibrin sealant does not improve wound healing. Dis Colon Rectum 35, 884–891 (1992). https://doi.org/10.1007/BF02047878

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