Effect of local and remote ischemia-reperfusion injury on healing of colonic anastomoses

Abstract

Background: Although the effect of locally applied ischemia-reperfusion (I-R) injury on gastrointestinal anastomoses has been studied, to our knowledge there is no previous study that investigates the effect of remote I-R injury on gastrointestinal anastomotic healing. The aim of this study was to investigate and compare the effects of local I-R injury and remote I-R injury on the healing of colonic anastomoses. Methods: Anastomosis of the right colon was performed in 30 rats that were divided into 5 groups. Group 1 was the control group. In Group 2, I-R was applied to the colonic segment containing the anastomosis. Unilateral lower extremity I-R, unilateral renal I-R, and segmental small intestinal I-R was applied to the rats in Groups 3, 4, and 5, respectively, at the same time as colonic anastomosis. On the fourth postoperative day, animals were killed and bursting pressure and tissue hydroxyproline concentration of the anastomoses were analyzed and compared. Results: The mean bursting pressure values were: 143 mm Hg in Group 1, 40.8 mm Hg in Group 2, 82.8 mm Hg in Group 3, 46.1 mm Hg in Group 4, and 52.3 mm Hg in Group 5 (P <.0001; 1-way analysis of variance). Mean tissue hydroxyproline concentration values were: 5.3 μg/mg in Group 1, 1.6 μg/mg in Group 2, 2.2 μg/mg in Group 3, 1.3 μg/mg in Group 4, and 1.5 μg/mg in Group 5 (P <.0001, 1-way analysis of variance). Bursting pressure and tissue hydroxyproline concentration values had a good correlation r = 0.86, P <.001, Pearson correlation analysis). Conclusions: This study showed that I-R injury is a systemic phenomenon, and remote organ I-R can significantly delay anastomotic healing. This has to be kept in mind when constructing an intestinal anastomosis in the presence of local or remote I-R injury. (Surgery 2000;128:99-104)