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To study new collagen formation in the healing of anastomoses in the right colon, five male Sprague-Dawley rats had single-layer colonic anastomosis performed. Five additional rats had suture of the colon with interrupted sutures without transection of the colon. Ten animals served as controls. One week after surgery, animals were given 3H-proline repeatedly to label new collagen formation during the second and third weeks. Animals were sacrificed three weeks after suturing or anastomosis. Two- or 10-mm segments were precisely excised on either side of the suturing or anastomoses. Total collagen and its total radioactivity were measured per segment. Collagen hydroxyproline and its radioactivity increased (100 per cent) only within 1 cm of the anastomosis or suture alone. No local or distant decrease in collagen was observed. Collagen formation in colonic wounds appears to be a local process.

結腸吻合には, Albert-Lembert内翻二層縫合が一般的に用いられてきたが, 最近の諸家の研究の結果, 断端一層縫合あるいは層別二層縫合の有効性が言われるようになった.しかし一層縫合では, 二層縫合と異なり, 一針の縫合糸のゆるみや, 一箇所の縫合糸間隔の広すぎがあっても, 吻合後早期の内容の漏れが起こる危惧があり, 縫合手技にはとくに注意が必要である.著者は, Gambee一層縫合における縫合手技について, 縫合糸間隔, 系の締め方が, 吻合創治癒にいかなる影響を与えるか, また吻合部もれ圧試験の意義に関して, 実験的研究を行ったので報告する.

雄ラットの低栄養状態下で, 結腸を切除, 吻合し, 種々の濃度 (5%, 10%, 15%, 20%) でモノアセトアセチン (Ma群) およびブドウ糖 (G群) を用いたTPNの効果を比較検討した.術後5日目の体重はG群, Ma群で, 投与カロリー量が同じ群ではほぼ同様の値を示した.血清Acetoacetate, β-hydroxybutyrateは5%Maを用いたM5群を除いてMa群で高値を示した, NバランスはMa群が全体的に良好な傾向を示し, 特にM5群と5%Gを用いたG5群で統計的に有意差がみられた.吻合部腸管耐圧力はMa群ではほぼ一定の値を示し, M5群とG5群の比較ではM5群が有意に高値を示した.以上の成績から, Maは低栄養, ストレス下のラットにおいては, 有効なエネルギー源であることが示唆された.

The effect of antibiotic colon preparation on the tensile strength and morphologic appearance of colonic anastomoses has been investigated in dogs. Preparation with preoperative kanamycin did offer a slight benefit over mechanical bowel cleansing. The addition of erythromycin and kanamycin to the preoperative bowel preparation significantly (p less than 0.001) improved the mean tensile strengh of the healing colonic anastomosis. Continuation of erythromycin and kanamycin for one week postoperatively almost doubled the mean tensile strength of the healing anastomosis. Continuation of erythromycin without kanamycin in the postoperative period provided little protection over the preoperative administration of kanamycin and erythromycin. Histologic examination showed that erythromycin and kanamycin given during the pre- and postoperative period changed the mode of healing from that of secondary intention to healing by first intention. The findings support the concept that soilage of the peritoneal cavity at the time of elective colon surgery is not as important as leakage caused by poor anastomotic healing. Antibiotic bowel preparation with kanamycin and erythromycin improves the healing of colonic anastomoses.

The changes in collagen, measured as hydroxyproline, concentration around both ileal and colonic anastomoses in germ-free and control rats have been investigated and compared with each other. The germ-free rats were raised, operated on and maintained under completely pyrogen-free conditions. Animals were killed 2, 3 or 7 days after operation. There was a significant reduction in the lowering of hydroxyproline concentrations around the colonic anastomosis of germ-free rats compared with control rats both in the anastomosis at days 2 and 3 (P = 0.04 and P = 0.006 respectively) and in the proximal segment at day 3 (P = 0.03). In ileal anastomoses, significant differences between control and germ-free rats were only found at 7 days. Here the increase in hydroxyproline concentration observed in control rats was significantly reduced in germ-free rats. These data are taken to support the hypothesis that bacteria affect colonic anastomotic healing by contributing to postoperative collagen degradation.

This report reviews the experience of pediatric surgeons in seven cities in North American and Western Europe where the Swenson procedure was performed on 880 patients. Information on the diagnosis, treatment, complications, and long-term results was collected by reviewing the hospital records, the treating physicians' office records, and by interviewing the patients in person or by telephone. A follow-up evaluation was obtained on 814 patients. The patients' ages at the time of the resection ranged from four days to 50 years. The length of follow-up averaged 10.3 years, while the longest follow-up was 39.5 years. The overall postoperative mortality was 2.4% during the entire 40 years of the study. The postoperative mortality has decreased to 1.25% for the last 20 years. Significant factors influencing postoperative mortality included Down's syndrome, the patient's age at the time of the operation, and leak of the distal colonic anastomosis. Most of the patients followed for over 5 years have normal bowel habits, report one to three bowel movements per day, and have no soiling. No patient has urinary incontinence or impotence.

To date, there have been no clinical investigations of the usefulness of drains following colonic anastomosis in elective operations. We report a prospective study in which 49 patients were randomized to have a corrugated silastic drain (Portex) placed next to the colonic anastomosis. These patients were compared with a control group of 57 patients who had no drain. The two groups were similar in age, sex, diagnosis and site of anastomosis. There was no difference in outcome between the two groups. Anastomotic leakage occurred in six patients in each group. Wound infections were noted in 10 patients in each group. Two patients with a drain and one patient without a drain died from leakage at the anastomosis. This study provides no evidence to support the use of a corrugated drain after anastomosis of the colon.

Sutureless colonic anastomosis using a biofragmentable anastomosis ring (BAR) has been evaluated in a prospective randomized comparison with sutures and staples for elective colorectal surgery. One hundred and one patients underwent BAR anastomosis, 85 a sutured anastomosis, and 16 a stapled anastomosis. There were two anastomotic leaks in the patients undergoing BAR anastomosis, seven in patients having a sutured anastomosis, and one in a patient who had a stapled anastomosis. Wound infection occurred in ten BAR patients, ten sutured patients and no stapled patient. There was no statistically significant difference in these or in other postoperative complications between the groups. The BAR was easy to use and is a safe alternative to sutures and staples for large bowel anastomosis.

The effect of povidone-iodine (0.1% available iodine) irrigation on colonic anastomosis healing was investigated in 196 Sprague-Dawley rats. Each end of the divided colon was irrigated with 5 ml of po

A randomized controlled trial to assess the effect of intravenously administered Trasylol on the healing of experimental colonic anastomoses in the rabbit has been performed. Before undergoing a standard left colonic resection and anastomosis, the animals received intravenous Trasylol (80,000 KIU). Postoperatively 160,000 KIU were given in divided doses per day for 3 days. Control animals received saline placebo. The mean bursting pressure of the anastomoses in the Trasylol-treated group was 47.7 +/- 3.0 mm Hg compared with 37.5 +/- 3.3 mm Hg for the control group (p less than 0.05). The mean difference in collagen content of the anastomosis compared to the resected specimen was +1.25 +/- 0.50 micrograms/mg and -1.02 +/- 0.47 microgram/mg for Trasylol and placebo, respectively (p less than 0.005). In this model intravenous Trasylol produces a significant elevation of the bursting pressure and a significant improvement in the collagen content of the anastomosis. This may be the result of collagenase inhibition.

The inverting, double-layer anastomosis required more time than the single-layer eversion. No significant difference in the degrees of inflammation after inversions and eversions was observed on microscopic examination. The degree of adhesion formation adjacent to the anastomoses was not appreciably different in the two types. Healing by restoration of mucosal continuity and fibroplasia appeared earlier in inversions than in eversions. Reduction of the lumen was greater by inversion, especially in the early postoperative period. Resistance to disruption by distention in inversions was greater than it was in eversions. However, after a lapse of nine days, eversions had adequate resistance to disruption. Local complications were less common after inversions than after eversions and the mortality rate after the former was appreciably lower than that after the latter.

Inverting methods of suture should be used in colonic anastomosis. A two-layer inverting anastomosis is usually recommended but it has been suggested that a single-layer technique is preferable and safer. Single-layer inverting, two-layer inverting, and everting anastomoses were compared in the unprepared rabbit colon. Everting anastomoses gave inferior results by comparison with both inverting methods with respect to tensile strength, anastomotic leakage, and histological evidence of healing, but no difference was found between the single-layer and two-layer methods using these criteria and measurement of colonic collagen. It was concluded that single-layer inverting methods of anastomosis had no particular advantages over the standard two-layer inverting method.

Summary The effects of a minor degree of hypovolaemia on colonic blood flow and on systemic haemodynamics have been studied in nine greyhound dogs. A loss in blood volume of 10 per cent over 20 min produced no change in blood pressure and only a 7 per cent rise in heart rate. Cardiac output, however, fell by 26 per cent and central venous pressure also fell significantly. Colonic blood flow fell by 28 per cent and oxygen availability by 29 per cent. All these changes were statistically highly significant. Retransfusion of shed blood resulted in a slow and incomplete return to pre-bleed status. Since colonic blood flow and oxygen availability during and after surgery may be important for colonic healing, it is suggested that even the slightest degree of hypovolaemia should be avoided in cases involving colonic anastomosis. Systemic blood pressure may be an inadequate index of the need for transfusion in these cases.

The effect of surgical drainage materials on rat colonic healing has been investigated in a prospective randomized and controlled study. Latex, silicone rubber (Silastic), polyvinylchloride (PVC) and polytetrafluoroethylene (Teflon) tubes were implanted alongside a colonic anastomosis and compared with a ‘no drain’ group using mechanical and histological assessments. There was a significant increase in anastomotic leakage in the latex group in which there appears to be a local inhibition of healing. Silastic, PVC and Teflon were not found to interfere with healing. The continued use of latex drains in colonic surgery is therefore questioned.

We feel that a pedicle graft of omentum makes an excellent protective wrapping about low anterior resections. We do not propose the technique to cover sloppily constructed anastomoses. Good nutrition, proper timing, adequate bowel preparation, and good surgical technique are the keys to successful low anterior resection, while omental pedicle grafting adds a further dimension in helping to assure a complication-free postoperative course.

Anastomotic leakage and dehiscence after gastro-intestinal surgery endanger the life of the patient. The incidence of anastomotic complications is especially high after surgery on the left colon; anastomotic leaks are reported to occur in 2%–7% of colonic anastomoses in general [1–3], and in up to 25% after anterior resections [1, 4]. Goligher et al. [5], using early postoperative contrast enemas, reported an incidence of anastomotic leakage after anterior resections of over 50%. However, most of these leaks were subclinical.

One hundred eighty left colonic single-layer end-on anastomoses performed on 90 rats by microsurgical techniques, using polydioxanone monofilament absorbable sutures, were examined histopathologically and microangiographically at nine different times, from two to 180 days. There was no anastomotic leakage. The vascular state after suturing and the evolution of the neovascularization are described. The neovascularization appeared to follow the same process of evolution as tissue restoration. It began early, was greatest on the seventh day, and diminished thereafter. When granulation tissue was narrow, the anastomoses were barely hypervascular, the neovascularization assured by submucosal plexus. A voluminous granulation tissue was hypervascular, had a slower evolution, and neovascularization was then assured above all by the peritoneal formations adherent to the suture.

The healing of an experimental left colon anastomosis protected by a proximal diverting colostomy was studied in the rat. Collagen synthesis in the anastomotic area was measured by incorporation of [3H]proline. With a defunctioning proximal colostomy, the synthesis and accumulation of collagen in the anastomosis was diminished, and the anastomotic strength development delayed and reduced. The development of anastomotic strength seems to proceed according to the level of strain from intraluminal bulk. As the healing of the anastomosis protected by a diverting colostomy was uncomplicated, these findings should not contra-indicate the use of diverting colostomy.

This study reports the preliminary results of a new totally stapled end-to-end colonic anastomosis in 11 dogs. This “triple-stapled” end-to-end anastomosis was performed with one circular staple line and two linear staple lines, eliminating the need for a colotomy or purse-string suture. The fact that the anvil and anvil stem of a new circular stapling device (Premium EEA™) can be detached from the frame of the instrument allows the anvil stem to be brought out through the proximal linear stapled colon. The trocar mounted on the main stem of the circular stapler allows the stem of the main device to be brought out through the distal staple line. Thus, a totally stapled colonic anastomosis is created after mating the anvil stem and main stem of the instrument. The new anastomosis was evaluated radiographically and at necropsy. The use of this technique resulted in no clinically detectable leaks, suggesting that it may facilitate the performance of anterior resections in humans.

The effect of an intraluminal tube on the healing of an inadequately constructed colonic anastomosis was evaluated. An anastomosis using a single suture was constructed in 78 rats divided into four experimental groups. In one, a latex tube was sited intraluminally at the level of the anastomosis and removed transanally after six days. In the second, a soft tube consisting of rat duodenum preserved in 5 percent formalin was similarly sited and allowed to pass spontaneously. In the third group, the formalin tube was placed outside the colon surrounding the anastomosis. The fourth group was a control. The mortality of the latex intraluminal tube group was 48 percent, the intraluminal duodenum in formalin group 29 percent (significantly less than the control group, P less than .02), the extraluminal tube around the anastomosis group 100 percent, and the control group 75 percent (P less than .02). There was no significant difference among the experimental groups in the mean breaking strength of the colonic anastomosis in the 28-day survivors.

The effect of a low-protein diet on the healing of colonic anastomoses in the rat was studied. The low-protein diet given for 2 weeks caused a weight loss of 11.9%. The healing of colonic anastomoses was assessed by bursting pressure measurement performance sequentially in the postoperative period. Compared to control animals, rats on a low-protein diet had significantly lower bursting pressures from the 4th to the 7th postoperative day. There was no difference in the hydroxyproline concentration at the anastomoses of the two groups of rats. These results suggest that the 5th postoperative day is the most appropriate time to investigate the effects of protein malnutrition on colonic healing in the rat.

Colonic intraluminal pressure was recorded in eight patients receiving either atropine 1.2 mg (n = 4) or glycopyrronium 0.6 mg (n = 4) intravenously in a randomised, double-blind fashion and followed after 5 minutes by neostigmine 2.5 mg. Estimations of total colonic activity were made from the area under the recording of intraluminal pressure. There were no significant differences in mean intraluminal pressures or total colonic activity between the two groups. It is concluded that glycopyrronium offers no advantage over atropine with respect to protection of the bowel against the effects of neostigmine.

An indwelling rectal tube that extends from the anus through a colonic anastomosis and well into the proximal limb of bowel has proved to be an excellent stent as well as an effective vent for maintaining bowel decompression after colonic resection.

Anastomotic leakage is a dreadful complication in colorectal surgery. It has a negative impact on postoperative mortality, long term life quality and oncological results. Nanofibrous polycaprolactone materials have shown pro-healing properties in various applications before. Our team developed several versions of these for healing support of colorectal anastomoses with promising results in previous years. In this study, we developed highly porous biocompatible polycaprolactone nanofibrous patches. We constructed a defective anastomosis on the large intestine of 16 pigs, covered the anastomoses with the patch in 8 animals (Experimental group) and left the rest uncovered (Control group). After 21 days of observation we evaluated postoperative changes, signs of leakage and other complications. The samples were assessed histologically according to standardized protocols. The material was easy to work with. All animals survived with no major complication. There were no differences in intestinal wall integrity between the groups and there were no signs of anastomotic leakage in any animal. The levels of collagen were significantly higher in the Experimental group, which we consider to be an indirect sign of higher mechanical strength. The material shall be further perfected in the future and possibly combined with active molecules to specifically influence the healing process.

Kale, Ebru/0000-0002-1194-6649; H, Ozturk/0000-0001-5608-5742; Akpolat, Veysi/0000-0002-2435-7800 WOS: 000270038600002 Background. Low-frequency magnetic fields have been shown to affect biological processes. In this article the effects of 50-Hz sinusoidal magnetic field (MF) stimulation and application of fibrin glue on the healing of experimental colonic anastomoses were investigated. Material and Methods. Twenty-eight rats were divided into four groups. Group 1 underwent 2-cm left colonic resection and primary anastomosis. Group 2 underwent normal resection anastomosis and the area was covered with fibrin glue. Group 3 underwent normal resection anastomosis and the rats were exposed to a 50-Hz sinusoidal MF. Group 4 underwent normal resection anastomosis, the anastomosis area was covered with fibrin glue, and the rats were exposed to a 50-Hz sinusoidal MF. Investigations included bursting pressure measurement, hydroxyproline content, and histopathological changes. Results. Tissue hydroxyproline levels and anastomotic bursting pressures of groups 2, 3, and 4 were significantly higher than in group 1. Collagen deposition and fibroblast infiltration in groups 2, 3, and 4 had higher scores than in group 1. Furthermore, these results were significantly higher in group 4 rats than in the other groups. Histopathological examination of the anastomosis revealed significantly better healing patterns for group 4 than for groups 1, 2, and 3. Conclusions. A50-Hz sinusoidal MF stimulation and application of fibrin glue provided a significant gain in anastomotic healing in the large intestine. A combination of a 50-Hz sinusoidal MF and fibrin glue has significantly favorable effects on healing of experimental colon anastomosis (Adv Clin Exp Med 2009, 18, 1, 13-18).

Background: Radiotherapy is one of the most important factors which results in negative effects on wound healing and increases anastomosis leakage. Diverting loop ileostomy has been usually performed after colorectal anastomosis in cases of colorectal cancer with a history of neoadjuvant radiotherapy to decrease the chance of leakage. Considering the side effects of diverting loop ileostomy, the objective of the present study is to investigate the effect of human amniotic membrane (HAM) on colorectal anastomosis leakage after neo-adjuvant radiotherapy. Methods: In this experimental animal study, 20 crossbreed rabbits were randomly divided into two groups (case group: 13 rabbits, control group: 7 rabbits) after receiving an equal dose of external beam radiation. Four weeks after irradiation, resection of 4 cm of colorectal segment and end-to-end single layer anastomosis were conducted. In the case group, a 2×2 cm wrap of HAM applied around the site of anastomosis. Eight weeks later, all the survived rabbits were sacrificed. A segment of anastomotic sites was resected in all expired and survived rabbits and sent for pathological evaluation. Mann-Whitney U Test (SPSS for Windows, Ver. 16, Chicago, IL) was applied to analyze healing scores between the two groups. Results: Due to anastomosis dehiscence, 5 rabbits expired in the control group, but all the 13 rabbits (case group) survived after 8 weeks and showed no leakage. In addition, pathological evaluation revealed significant epithelialization and neovascularization in the case group. Statistically, healing score was higher in the case group rather than the control group (P

• To evaluate the management of colonic injuries, experimental models simulating acute injuries of the colon were studied utilizing New Zealand white rabbits. Seventy-nine rabbits underwent primary repair of colonic injuries in the presence of massive contamination and none showed any evidence of anastomotic leakage or breakdown. The fact that primary colonic repairs do heal even in the presence of infection suggests that breakdown of colonic anastomosis results from factors other than infection. Despite the absence of anastomotic leaks in this series, morbidity and mortality were high in those animals not given antibiotics. The high morbidity and mortality were due to peritonitis, intra-abdominal abscess, and wound infection, and were directly proportional to the length of time from colonic injury to repair. On the basis of this study, it is concluded that most isolated injuries of the colon can be closed primarily, if antibiotic therapy is begun immediately after injury and is continued throughout the operative and postoperative periods. ( Arch Surg 111:78-80, 1976)

From 574 patients with carcinoma of the colon, 111 anastomotic sites have been reviewed. After 3 months the appearance of the colonic anastomosis is well stabilized. The first postoperative barium enema examination will serve as a baseline appearance for future comparison and should be done approximately 3 months following surgery. The distinction between a normal anastomosis and a recurrence may hinge upon the demonstration of minor changes of length of narrowing or caliber of lumen. The high incidence of second, new primary lesions must alert the radiologist to a meticulous examination of the entire remaining colon. Limited air barium contrast studies will provide the sharpest roentgenograms of the anastomosis on the left side.