Relationship between peritoneal adhesion phenomena and the experimental resistance of colonic anastomoses: influence of omentoplasty.

Abstract

The repair processes that follow surgical injury constitute the physiopathological basis of peritoneal adhesion phenomena. The aim of the present study was to investigate the influence of the peritoneal adhesion process on the resistance of colonic anastomoses during the early postoperative period. Sixty Sprague-Dawley rats were divided into three groups (n = 20 each) according to procedure: transverse colon section and anastomosis (group 1); omentoplasty performed on the anastomosis (group 2), and thin latex sheeting covering the anastomosis (group 3). The rats were sacrificed 4 days after surgery and the adhesion evaluated. The segment containing the anastomosis was removed and the bursting pressure determined; the diameter and Laplace's law were used to calculate the bursting wall tension (BWT). The mean BWT in group 1 was 30.73 dyn. 10(3)/cm. In the multivariate analysis, adhesions to the anastomotic line were found to exert the greatest influence on the BWT (p = 0.005). The mean BWT of the anastomoses with adhesions affecting 100% of the circumference was greater than when at least part of the latter remained free (p = 0.006). In group 2 the BWT was 55.92 dyn. 10(3)/cm, i.e., greater than in group 1 overall (p = 0.005) and similar to those anastomoses in that group completely covered by adhesions (p = 0.017). Mean BWT in group 3 was 14.62 dyn. 10(3)/cm, i.e., lower than in either group 1 or 2 (p = 0.009 and 0.000, respectively). No differences were seen when comparing with group 1 segments in which the anastomotic line was not entirely covered. Adhesions to the anastomotic line exert a beneficial effect on colonic anastomotic resistance 4 days after surgery. Adhesion formation should therefore not be interfered with. An omentoplasty secures 100% coverage of the anastomotic line, and should thus be considered when performing high-risk colonic anastomoses.