Artikel
Crystalloid infusion leads to inflammatory cell infiltration of the anastomosis and thus disturbs anastomotic healing
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Veröffentlicht: | 20. Mai 2011 |
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Introduction: Stability of small bowel anastomoses significantly depends on the amount (Marjanovic et al., Ann Surg 2009) and on the type (Marjanovic et al, IJCD 2010) of the infused solution. For further examination, we assessed the process of cellular infiltration of the anastomosis depending on the amount and on the type of infused fluid.
Materials and methods: 32 Wistar rats were randomized into four groups (n=8), receiving either a crystalloid (Jono Steril) or a colloid (Voluven® http://www.fresenius-kabi.at/internet/kabi/at/fkintpbn.nsf/Content/MERKMALE+VOLUVEN+LOGIN) infusion in different amounts: fluid restriction (Jonosteril = J (-) und Voluven = V (-)) with an infusion rate of 3 ml/h*kgbw and fluid overload (J (+); V (+)) with 36 ml/h*kgbw. Infusion time was 60 min. We performed an end to end ileo-ileostomy. On 4th POD the rats were reoperated and the anastomoses prepared. Histologic assessment (HE staining) of a wound healing score according to Verhofstad, 2001 was done in a blinded manner by two pathologists. This score implements the semiquantitative specification of necrosis, mucosal or submucosal defects, as well as the number of lymphocytes, macrophages and neutrophile granulocytes of the anastomosis. Statistical analysis was performed with Kruskal-Wallis and Mann Whitney U test (significance p<0.05).
Results: A significant difference in between the four groups was found regarding the the number of lymphocytes and the total number of inflammatory cells (lymphocytes, macrophages and neutrophile granulocytes. The number of lymphocytes and the total number of inflammatory cells was significantly higher in crystalloid overload group (J(+) vs. V(+); p= 0,024 / J(+) vs. V(-); p=0,016), whereas there were no significant differences compared to crystalloid restriction group (J(+) vs. J(-)). Further significant differences were not found.
Conclusion: Crystalloid fluid overload leads to a significant inflammatory cell infiltration of the anastomosis. An increased inflammation of the anastomotic region might be the pathophysiological explanation for the reduced anastomotic stability as well as for the reduced collagen content after perioperative crystalloid overload.