ABSTRACT
OBJECTIVE:
Anastomotic healing appears to be of utmost importance in gastrointestinal surgery. Leakage of anastomosis is associated with a variety of major problems. 8-29 % of patients with colorectal tumors present with colonic obstruction. Morbidity rates with colon anastomosis especially in emergency setting is relatively high. Resection of the right colon followed by primary anastomosis is the procedure frequently conducted in emergency cases whereas resection and primary anastomosis in the left colon obstructions remains to be controversial. In the present study, obstruction of both sides were established and primary anastomosis was carried out in an experimental model. The results of anastomotic healing were compared both macroscopically and microscopically.
METHODS:
A total of 40 rats were assigned into two groups, 20 in each. Right colon obstruction was established in one group and left colon obstruction in the other. The rats underwent colon resection and primary anastomosis after 24 hours. The rats were sacrificed on 7th and 14th days following anastomosis. Anastomotic leakage, bursting pressure and tissue hyroxyproline levels in the area of anastomosis and the healthy tissue 1 cm distal to anastomosis were evaluated. Histopathological analysis of anastomotic area was done.
RESULTS:
No leakage of anastomosis was detected. Anastomotic bursting pressure levels were similar between the two groups. Tissue hydroxyproline levels were not shown to be significantly different between the groups except for the samples obtained from the healthy area that is 1 cm distal to the anastomosis on the 7th day (p=0.002, p=0.318, p=0.253). Histopathological examination of left colon on 14th day revealed granulation tissue where fibroblastic activity was dominant, whereas granulation tissue with prominent fibroblastic activity containing chronic inflammatory cells in right colon.
CONCLUSION:
Healing of anastomosis following resection appears to be similar between right and left colon obstructions. Resection and primary anastomosis in left colon obstruction is a safe procedure.
