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

Abstract

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 × 10−4) or hypertonic glucose (29.5(10.1) N/m × 10−4) compared with controls (12.2(12.1) N/m × 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) μg/mg) or hypertonic glucose (11.6(2.9) μg/mg) than in controls (8.9(1.5)μg/mg). Anastomotic healing is improved by all types of intraoperative colonic lavage, particularly with SCFA and hypertonic glucose solutions.