Effect of Surgical Technique on Intestinal Anastomotic Healing in Steroid-Treated RabbitsLanger J.C. · Srinathan S.K. · Pelletier G.J.
Division of Pediatric Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo., USA
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Background: Patients who receive chronic corticosteroid therapy and undergo intestinal resection suffer an increased incidence of anastomotic leak or dehiscence. Surgeons differ with respect to which anastomotic technique is optimal in these patients. We used a steroid-treated rabbit model to compare intestinal healing following three commonly used anastomotic techniques. Methods: Adult rabbits were treated with intramuscular hydrocortisone (3 mg/kg) for 2 weeks preoperatively and 1 week postoperatively. A small bowel and colonic anastomosis was done in each animal using a single layer of silk (n = 10), double layer of chromic and silk (n = 8), or functional end-to-end stapled technique (n = 8). One week later the anastomoses were evaluated by gross appearance and by in vivo measurement of bursting pressure. Results: There was no difference among groups with respect to gross anastomotic dehiscence in either small bowel or colon. In the colon, double layer anastomoses had a signifivantly higher bursting pressure than either single layer or stapled anastomoses (p = 0.016, one-way ANOVA). The same trend was present in the small bowel, although it did not reach statistical significance (p = 0.182). Conclusions: These data suggest that there may be an advantage to double layer anastomoses in steroid-dependent patients, particularly following colon resection. Clinical studies must be done to confirm this impression.
© 1996 S. Karger AG, Basel
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