Abstract
BackgroundLeakage following colorectal anastomosis surgery causes various complications associated with high morbidity and mortality, especially in pediatric patients. It might be caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs) as postoperative analgesics. This study aimed to compare the effect of metamizole and paracetamol on colonic anastomosis and fibroblast activities, including proliferation, migration, and collagen synthesis, in Wistar rats.MethodsRats were divided into control, paracetamol and metamizole groups. The colonic anastomosis was evaluated by determining the integrity of the muscle layers, the formation of granulation tissue, and mucosal anastomosis. Fibroblast activities were analyzed by measuring the proliferation, migration, and collagen synthesis.ResultsMetamizole caused more damage to muscle layer integrity, more inhibition of granulation tissue formation in the anastomosis area and lower mucosal anastomosis compared with paracetamol and control groups. Metamizole had a higher cytotoxic effect than paracetamol, which suppressed the proliferation and migration of fibroblasts. Furthermore, both drugs did not affect the synthesis of collagen.ConclusionMetamizole shows worse effects on the integrity of muscle layers, inhibition of granulation tissue formation, mucosal anastomosis, fibroblast proliferation, and migration, but not collagen synthesis, than paracetamol in Wistar rat intestines following colonic anastomosis. These findings might indicate that paracetamol is safer than metamizole as analgesic following colonic anastomosis.
Highlights
Leakage following colorectal anastomosis surgery causes various complications associated with high morbidity and mortality, especially in pediatric patients
In vivo metamizole and paracetamol effect on intestinal anastomosis Histopathological findings showed more anastomosis failure in the metamizole group compared with the paracetamol and control groups (Fig. 1) Damage to the muscle layers as well as inflammatory tissue and granulation which occurred in the anastomosis area were assessed using the scoring system from histological samples (Fig. 2)
It was found that muscle damage in the colonic anastomosis area was more severe in the metamizole group (1.57 ± 0.8) compared to paracetamol (3 ± 1.3) and control (3.86 ± 0.38) with a value of p < 0.05
Summary
Leakage following colorectal anastomosis surgery causes various complications associated with high morbidity and mortality, especially in pediatric patients. It might be caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs) as postoperative analgesics. Anastomotic leakage is the most serious complication of colorectal surgery that significantly increases the morbidity and mortality rate of the patients [1]. Many factors contribute to anastomotic leakage, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) as postoperative analgesics [5]. Fibroblasts are essential cells that are important in the wound healing process. Fibroblasts are found in the intestinal tissue which become active after anastomotic surgery to activate other cells in the wound healing process [6]
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