Berstungsdruck, Expressionsverhalten von MMP13 und VEGF von genähten und geklebten kolorektalen Anastomosen im Rattenmodell

Abstract

Introduction and objective: High insufficiency rates of up to 25 % and a mortality rate of up to 50 % in insufficiency of colorectal anastomoses clearly illustrate the problems of surgical interventions. The management of such insufficiencies and if necessary the primary protection of the anastomosis by use of a glue-on collagen fleece is a possible tool to influence the rate of insufficiency and the deleterious course. The objective of this study was to compare sutured and glued anastomoses in the rat model. The target parameters were the anastomotic bursting pressure, expression of MMP 13 and VEGF. Material and methods: 60 male Wistar rats were randomised into 2 groups. Group I: circular sutured anastomosis at the rectosigmoid junction. Group II: semicircular sutured anastomosis and closure of the anterior wall with fibrin-coated collagen fleece (Tachosil^®). Five animals were measured at each examination point. The bursting pressure was measured in situ after 12, 48 and 120 hours. After euthanasia each animal was tested for expression of MMP 13 and VEGF of the anastomosis by Real-Time-PCR Results: 1: Over 48 hours sutured anatomoses showed significantly higher bursting pressures than glued anastomoses. After 120 h the glued anastomoses showed significantly higher bursting pressures. 2: The comparison of both groups showed significant difference as regards MMP 13 at 48 and 120 h and a possitiv trend for VEGF after 12 and 48 h. Conclusion: The bursting pressure, MMP13 and VEGF indicate comparable stability of the anastomoses in both groups. In case of insufficiency of an anastomosis, glue-on anastomosis using collagen fleece could stimulate the matrix for scar formation and thus promote healing since sutures alone cannot stabilize the surgical wound.