Abstract
To investigate the effects of pneumoperitoneum on colonic anastomosis healing. Colonic anastomosis was performed in 120 rats divided into four groups: Group I - pneumoperitoneum before laparotomy, Group II - pneumoperitoneum after laparorrhaphy, Group III - pneumoperitoneum before laparotomy and after laparorrhaphy, Group IV - no pneumoperitoneum (control group). Pneumoperitoneum pressure was 5 mmHg. Animals were killed on the 3rd, 7th and 14th postoperative day. Histopathological features, anastomosis breaking strength, collagen histomorphometry and hydroxyproline concentration were assessed. Breaking strength between groups: (day 3, p=0.165; day 7, p=0.219; day 14, p=0.539). Histopathology revealed that group II had, on day 7, less infiltration of mononuclear cells (p=0.006), greater infiltration of polymorphonuclear cells (p=0.001) and greater necrosis (p=0.001); and on day 14, less fibrosis. Histomorphometry revealed a decrease in collagen in groups I and III (p<0.001) on day 7 and an increase in groups I and II on day 14 (p<0.001). Hydroxyproline concentration was similar for groups on days 3 (p=0.152), 7 (p=0.913) or 14 (p=0.981). Carbon dioxide does not impair the healing of colonic anastomosis in rats.
Highlights
MethodsThe ability of the human body to heal a gastrointestinal anastomosis is a fascinating event
After the publication of the Clinical Outcomes of Surgical Therapy (COST) study in 2004, which demonstrated that laparoscopy had similar results to those of open surgery in the treatment of colon cancer, but better postoperative outcomes[8], many surgeons were excited about the procedure
This study evaluated the possible effects of pneumoperitoneum with carbon dioxide in the healing of colonic anastomosis
Summary
The ability of the human body to heal a gastrointestinal anastomosis is a fascinating event. Despite the increasingly frequent use of pneumoperitoneum in colorectal surgery, few studies have evaluated its effect on the healing of intestinal anastomosis[15,16,17,18,19,20,21]. Increased intra-abdominal pressure caused by pneumoperitoneum may lead to systemic effects, such as acid-base imbalance, blood gas alterations, and pulmonary, cardiovascular, and renal impairment[25,26,27,28] Another important result of increased intra-abdominal pressure is a decrease in splanchnic blood flow, which may lead to ischemia of the colon during laparoscopic colectomy and increase bacterial translocation and fistulas[17]. In groups II and III, pneumoperitoneum was performed at a pressure of 5 mmHg for 30 minutes after the abdominal wall was sutured
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