Abstract
Introduction: The restoration of bowel continuity using multiple classic anastomoses is mostly
impossible in unstable critically ill extremely low birth weight neonates. The parameters
of healing of approximative anastomoses in which integrity and continuity of bowel
is achieved with limited number of stitches were evaluated in an experimental study.
Material and Methods: Small bowel anastomoses were performed in twenty-two adult male rats. An approximative
ileo-ileal anastomosis was performed with five seromuscular-interrupted sutures only;
in the control group the anastomosis was performed with the conventional technique
of interrupted sutures. The mechanical and biochemical parameters were compared. Results: All anastomoses in both groups healed well without obstruction. The mean operating
time needed for an approximative anastomosis was shorter (16 ± 7.1 min versus 23.6 ± 6.2 min,
p = 0.016). The strength of the approximative anastomoses on the 1st day after surgery
was 55 ± 15 torr; the strength of the conventional anastomoses was 55 ± 42 torr. The
strength of the approximative anastomoses after 7 days was 249 ± 39 torr; the strength
of the conventional anastomoses was 218 ± 23 torr (p = 0.118). The activity of the
collagenolytic enzymes matrix metalloproteinase-2 and matrix metalloproteinase-9 in
the anastomotic area was significantly increased compared with the activity in samples
of non-operated bowel. There was no significant difference in collagenolytic activity
between both types of anastomoses. Conclusion: The approximative anastomosis is a time-saving alternative to conventional anastomoses
with a comparable course of anastomotic healing, anastomotic strength, and changes
in collagen metabolism.
Key words
approximative anastomosis - matrix metalloproteinase - anastomotic strength - extremely
low birth weight neonates
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M.D., Ph.D. Michal Rygl
Department of Pediatric Surgery
Charles University in Prague – 2nd Medical School
V Uvalu 84
15006 Prague
Czech Republic
eMail: mrygl@yahoo.com
