RELATIONSHIP BETWEEN PERITONEAL ADHESION PHENOMENA AND THE EXPERIMENTAL RESISTANCE OF COLONIC ANASTOMOSES - INFLUENCE OF OMENTOPLASTY

The repair processes that follow surgical injury constitute the physio pathological basis of peritoneal adhesion phenomena. The aim of the pr esent study was to investigate the influence of the peritoneal adhesio n process on the resistance of colonic anastomoses during the early po stoperative period. Sixty Sprague-Dawley rats were divided into three groups (n = 20 each) according to procedure: transverse colon section and anastomosis (group 1); omentoplasty performed on the anastomosis ( group 2), and thin latex sheeting covering the anastomosis (group 3). The rats were sacrificed 4 days after surgery and the adhesion evaluat ed. The segment containing the anastomosis was removed and the burstin g pressure determined; the diameter and Laplace's law were used to cal culate the bursting wall tension (BWT). The mean BWT in group 1 was 30 .73 dyn. 10(3)/cm. In the multivariate analysis, adhesions to the anas tomotic line were found to exert the greatest influence on the BWT (p = 0.005). The mean BWT of the anastomoses with adhesions affecting 100 % of the circumference was greater than when at least part of the latt er remained free (p = 0.006). In group 2 the BWT was 55.92 dyn. 10(3)/ cm, i.e., greater than in group 1 overall (p = 0.005) and similar to t hose anastomoses in that group completely covered by adhesions (p = 0. 017). Mean BWT in group 3 was 14.62 dyn. 10(3)/cm, i.e., lower than in either group 1 or 2 (p = 0.009 and 0.000, respectively). No differenc es were seen when comparing with group 1 segments in which the anastom otic line was not entirely covered. Adhesions to the anastomotic line exert a beneficial effect on colonic anastomotic resistance 4 days aft er surgery. Adhesion formation should therefore not be interfered with . An omentoplasty secures 100% coverage of the anastomotic line, and s hould thus be considered when performing high-risk colonic anastomoses .