D. Garciaolmo et al., RELATIONSHIP BETWEEN PERITONEAL ADHESION PHENOMENA AND THE EXPERIMENTAL RESISTANCE OF COLONIC ANASTOMOSES - INFLUENCE OF OMENTOPLASTY, European surgical research, 28(4), 1996, pp. 315-322
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
.