Liver cirrhosis on the colonic anastomotic healing in rats

Marcelo Di Bonifácio,Rogério Serafim Parra,Ana Luiza Normanha Ribeiro De Almeida,Omar Feres,José Joaquim Ribeiro Da Rocha

doi:10.1590/s0102-86502011000600002

Abstract

To investigate the effects of cirrhosis on colonic anastomosis healing in rats. Fifty five Wistar male rats were used (23 in the control group and 32 in the cirrhosis group). On the first day of the procedure, the rats in the cirrhosis group underwent double ligation and folding of the common bile duct to induce liver cirrhosis, and the control rats underwent a laparotomy and intestinal manipulation. On the fourteenth and thirty-fifth days, all of the animals were biochemically assessed for serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase, bilirubin, total protein, and albumin and for liver histopathology. On the thirty-fifth day, cirrhosis was confirmed. On the twenty-eighth day, all of the animals were subjected to left colon transection and anastomosis. On the seventh day after the colonic anastomosis, the rats were sacrificed and macroscopically evaluated for dehiscence. The region of the colonic anastomosis was removed and subjected to hydroxyproline content measurement, conventional histology, and the immunohistochemical determination of vascular endothelial growth factor (VEGF) and matrix metalloproteinase type 1 (MMP 1). The biochemical and histopathological examinations confirmed cirrhosis in all of the animals in the cirrhosis group. More deaths occurred after anastomosis in the cirrhosis group (5/25) than in the control group (0/21), and anastomotic dehiscence was more frequent in the cirrhosis group (8/25) than in the control group (0/21). The average hydroxyproline concentration was lower in the cirrhosis group than in the control group. The immunohistochemical studies showed that the average VEGF expression in the cirrhosis group was lower than in the control group, and the average MMP1 expression was higher in the cirrhosis group. Hepatic cirrhosis leads to increased mortality and colonic anastomotic dehiscence, an increased distance between the mucosal edges of the anastomosis area, and a lower hydroxyproline concentration in the colonic anastomosis; therefore, these conditions are deleterious to healing.

Highlights

Anastomotic dehiscence is a serious complication that occurs after gastrointestinal tract operations[1] and increases morbidity and mortality in patients[2,3,4,5,6,7]
This study evaluated the influence of hepatic cirrhosis on the healing of colonic anastomosis
The rats in the cirrhosis group were injected with 0.2 ml of a solution containing 0.02 ml of vitamin K diluted in 0.2 ml of saline

Summary

Introduction

Anastomotic dehiscence is a serious complication that occurs after gastrointestinal tract operations[1] and increases morbidity and mortality in patients[2,3,4,5,6,7]. Local, and systemic factors influence the occurrence of colonic anastomotic dehiscence. Certain systemic conditions, such as hypotension, hypovolemia, intestinal ischemia, low oxygen tension, advanced malignant neoplasia, dehydration, uremia, age and malnutrition, can affect healing[8,9,10,11,12,13,14]. Some studies have shown a higher incidence of colonic anastomotic dehiscence in patients with intraoperative hypotension, anemia, and cirrhosis[1,6]. Some studies have shown that liver cirrhosis interferes with the healing of abdominal incisions and decreases collagen in these areas, which leads to dehiscence[15,16,17,18,19]. This study evaluated the influence of hepatic cirrhosis on the healing of colonic anastomosis

Methods

Results

Conclusion