N. Duraker et al., Intraoperative bowel irrigation improves anastomotic collagen metabolism in the left-sided colonic obstruction but not covering colostomy, INT J COL R, 13(5-6), 1998, pp. 232-234
This study investigated the effects of intraoperative colonic irrigation an
d proximal diverting end colostomy after segmental bowel resection in exper
imental left-colonic obstruction on anastomotic healing. Simple obstruction
of descending colon was performed in male Sprague-Dawley rats. After 24 h
we performed segmental colonic resection and anastomosis in the control gro
up (n=15); resection, anastomosis, and covering colostomy in the colostomy
group (n=14); resection and anastomosis after antegrade colonic lavage thro
ugh cecum by using isotonic saline solution in the irrigation group (n=13).
In rats that were killed 7 days later anastomotic dehiscence and bursting
pressure and tissue hydroxyproline concentration at the anastomosis were me
asured. No significant differences were observed between groups in terms of
anastomotic dehiscence, bursting site, or pressure. The hydroxyproline con
centration was significantly higher in the irrigation group than the contro
l group (P = 0.025) and the colostomy group (P = 0.029), but no difference
was noted between the control group and the colostomy group. These findings
suggest that intraoperative antegrade colonic irrigation in the acute left
-sided colonic obstruction positively affects collagen metabolism at the an
astomotic site; if the anastomosis is performed without bowel cleansing, co
vering colostomy does not improve collagen metabolism.