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128. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

03.05. - 06.05.2011, München

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Crystalloid infusion leads to inflammatory cell infiltration of the anastomosis and thus disturbs anastomotic healing

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  • Birte Kulemann - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Philipp Holzner - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Simon Kuesters - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Woiciech Konrad Karcz - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Jodok Grüneberger - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Sylvia Timme - Institut für Pathologie, Freiburg
  • Axel zur Hausen - Institut für Pathologie, Freiburg
  • Olivia Sick - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Ulrich Theodor Hopt - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Jens Höppner - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Goran Marjanovic - Universitätsklinik Freiburg, Allgemein- und Viszeralchirurgie, Freiburg

Deutsche Gesellschaft für Chirurgie. 128. Kongress der Deutschen Gesellschaft für Chirurgie. München, 03.-06.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dgch077

doi: 10.3205/11dgch077, urn:nbn:de:0183-11dgch0771

Published: May 20, 2011

© 2011 Kulemann et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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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.