Enhanced intra-anastomotic healing by operative lavage with nutrient solutions in experimental left-sided colonic obstruction.

Abstract

The influence of intraoperative lavage with various solutions was tested on the healing of experimental colonic anastomoses performed in the presence of obstruction. After 24 h of ligature obstruction to the pelvic colon, male Wistar rats (n = 108) underwent colonic resection and primary anastomosis, using lavage with one of four different fluids: saline, povidone-iodine, 10 per cent hypertonic glucose and short-chain fatty acids (SCFA). Controls had no lavage. The anastomotic segment was excised and studied after 3 or 6 days. At day 3, mean(s.d.) bursting pressure was significantly greater in animals receiving SCFA compared with controls (81.2(23.0) mmHg versus 34.8(34.0) mmHg). Mean(s.d.) bowel wall tension was higher in rats with SCFA (30.6(8.1) N/m x 10(-4) or hypertonic glucose (29.5(10.1) N/m x 10(-4) compared with controls (12.2(12.1) N/m x 10(-4). By day 6, the anastomosis was more resistant to intraluminal pressure in each lavage group; mean(s.d.) hydroxyproline concentration at the anastomosis was greater in rats with SCFA (12.4(1.5) micrograms/mg) or hypertonic glucose (11.6(2.9) micrograms/mg) than in controls (8.9(1.5) micrograms/mg). Anastomotic healing is improved by all types of intraoperative colonic lavage, particularly with SCFA and hypertonic glucose solutions.