EXPERIMENTAL AND CLINICAL JUSTIFICATION OF THE USE OF COLLAGEN-FIBRIN ADHESIVE COMPOSITION FOR CLOSING A COLON DEFECT

Abstract

Relevance: The aim of our study was to assess the degree of penetration of the intestinal area by connective tissue when using a collagen plate in rats with a colon defect. Increasing the efficiency of surgical treatment of pararectal fistulas.
 An experimental morphological study was carried out on laboratory rats of the Wistar line, which were divided into two groups consisting of 20 animals each, depending on the method of closure of the intestinal wall defect: group 1 main and group 2 comparison.
 The average weight of animals in each group was 180 ± 220 g.
 For the purpose of anesthesia, a sodium thiopental solution was used, which was prepared as follows: 1 g of sodium thiopental was diluted in 20 ml of 0.9% sodium chloride solution. Each animal was injected with 0.7 ml of a 0.5% solution.
 In the main group, the operation of closing the defect of the intestinal wall was carried out using a collagen-fibrin adhesive composition. In the comparison group, the operation of closing the defect of the intestinal wall was performed with interrupted sutures.
 At the end of the experiment, the animals were euthanized in equal numbers from each group, subject to the conditions of euthanasia, 10, 30, 60 days after surgery.
 As a result of the experimental study, the animals of the main group and the comparison group were all alive on day 10 after surgery.
 Morphological changes in histological samples of the large intestine with the closure of the intestinal wall defect with a collagen-fibrin adhesive composition consisted in pronounced leuko-lymphocytic cell infiltration. Individual infiltrates were observed that formed lymphoid follicles.
 An objective assessment of the immunohistological analysis of the samples of the operated intestine in animals from the comparison group at the same time showed the presence of a defect in the muscle layer with fragments of granuloma formed around the suture material. Filaments, multinucleated giant cells of a foreign body, epithelioid cells, mature dense connective tissue, and coarse collagen fibers were visualized in the samples. Also, in the samples of the intestine near the site of the defect, one can see the absence of complete restoration of the mucous-producing function of the glandular epithelium at the border with the site of damage, as evidenced by the uneven staining of vacuoles with mucin, a decrease in their number. These results indicate the advantage of proliferative inflammation processes with the formation of formed granulomas, foreign bodies around the surgical suture material. Morphological signs are characteristic of the surgical recurrent course of the inflammatory process in the intestinal wall, which was additionally provoked and supported by suture material. The use of the technique of nodular suturing of the intestinal wall defect in the experiment led to uneven germination of connective tissue around the suture material with foci of pronounced productive inflammation.
 Immunohistological studies have shown that the use of a collagen-fibrin adhesive composition minimizes the inflammatory reaction in the intestinal wall, accelerates regeneration processes and contributes to the anatomical restoration of the integrity of all layers in the defect zone. The postoperative results showed that among the patients of the main group, after three months of surgery, the recurrence of the perrectal fistula occurred in 1 patient with a collagen-fibrin adhesive composition (1.6%) concomitant type 2 diabetes mellitus. Among the patients of the comparison group, 5 patients (8.3%) had recurrent-prolonged wound infection.
 The introduction of a collagen-fibrin adhesive composition into the surgical treatment of pararectal fistulas increases the effect of treatment, namely, a decrease in the recurrence rate of 1.6% versus 8.3% in the comparison group.