BACTERIA - A MAJOR PATHOGENIC FACTOR FOR ANASTOMOTIC INSUFFICIENCY

The aim of this study was to determine the influence of bacteria on th e development of anastomotic insufficiency following gastrectomy in th e rat. Fifty-seven male Wistar rats were randomly assigned to three gr oups and subjected to gastrectomy. Group I (n = 20) was orally inocula ted with 10(9) Pseudomonas aeroginosa organisms on postoperative day 1 . Group II (n = 20) served as the control group. Group III (n = 17) wa s decontaminated with 320 mg of tobramycin, 400 mg of polymyxin B, and 500 mg of vancomycin per liter of fluid administered from preoperativ e day 7 to postoperative day 10. Swabs from the oropharynx and rectum were cultured and analyzed daily for gram-positive and gram-negative b acteria. Surviving animals were sacrificed on postoperative day 10. Al l animals were autopsied immediately following death. Anastomotic insu fficiency was defined as a histologically proven transmural defect at the suture line. Along with an effective reduction of pathogenic bacte ria colonizing the oropharynx, the rate of anastomotic insufficiency c ould be reduced significantly, to 6% in decontaminated animals compare d with 80% in controls (P < 0.001 by Fisher's exact test). Inoculation of group I animals with P. aeruginosa led to an increase of anastomot ic insufficiency up to 95% and a significant increase in mortality (P < 0.05). We conclude that bacteria play a major role in the pathogenes is of anastomotic insufficiency following gastrectomy in the rat.