Einfluss verschiedener Mengen an kristalloiden Infusionslösungen auf die Stabilität enteraler Anastomosen im Kleintiermodell

Abstract

Background. Anastomotic insufficiency still remains an unsolved problem in digestive surgery. Little clinical data regarding the impact of perioperative volume management show less complications in intestinal surgery for restrictive volume regimes. The aim of our study was to examine the effect of the extent of the intraoperative volume substitution with cristalloids on the stability of intestinal anastomoses. Material and methods. 21 rats were randomly assigned to three groups (n = 7 rats/group): control group Co (9 ml/h*kgbw cristalloid infusion Iono Steril^®), volume restriction group V (−) (3 ml/h*kgbw) and the group with volume overcharge V (+) (36 ml/h*kgbw). After midline incision all animals received the corresponding infusion for a 30 minutes period. The infusion was continued for further 30 minutes while performing the anastomosis. An end-to-end small bowel anastomosis 15 cm proximal to the Bauhin valve was performed with 8 interrupted inverting sutures (Ethilon^® 8/0). At reoperation on 4^th postoperative day the anastomotic segment was prepared and measurement of the bursting pressure [mmHg] was performed. As second parameter for the quality of the anastomotic healing hydroxyproline concentration was determined with a spectrophotometric method [µg/g dry tissue]. Data are given as mean ± SEM. P < 0.05. Results. An anastomotic insufficiency was not found in the groups. The bursting pressure of Co group was 102 ± 8 mmHg. In V (+) with high volume exposure bursting pressure was lowest with 77 ± 6 mmHg and significantly lower compared to V (−) (112 ± 9 mmHg; p = 0.01) while the difference compared to the control group did not reach significant values. Hydroxyproline concentration in V (+) was significantly lower compared to V (−) animals (p < 0.05). Conclusion. On the basis of our experimental data, we are the first to prove that the amount of the intraoperatively applied cristalloids has a significant impact on functional (bursting pressure) and structural (hydroxyproline) stability of intestinal anastomoses on 4^th postoperative day. Since the stability and quality of an intestinal anastomosis have an impact on the insufficiency rate, this — at least in an animal model — seems to be significantly affectable by a restrictive volume management.