Article
Pringle maneuvre increases the risk for anastomotic dehiscence after colon resection in rats
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Published: | April 24, 2015 |
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Introduction: Synchronous liver metastases are found in 30-50% of patients with colorectal cancer. While some groups report excellent results from synchronous resections of the primary tumor and liver metastases, others report an increased incidence of anastomotic dehiscence after synchronous resections. We therefore evaluated the influence of the Pringle`s maneuver on the healing of colonic anastomoses in rats.
Material and methods: Male wistar rats underwent a median laparotomy under inhalation anaesthsia with isoflurane. After a sigmoid resection with end-to-end anastomosis by single stitches (6-0 prolene) rats received either a 25 minutes Pringle´s maneuver (PM) using a mirovascular clamp or were kept under anesthesia for the same period. The anastomotic burst pressure was measured ex-vivo on days 3, 6 and 9 after surgery. Also, the tissue hydroxyproline content was assessed as second parameter for anastomotic healing. Results were compared using the Mann-Whitney U-test, p<0.05 was considered significant.
Results: In both groups, animals lost body weight within the first 3 days of the experiment (95.7%, vs. 85.1% p=0.043). While rats gained weight after sigmoid resection, body weight further decreased after sigmoid resection and PM on days 6 (118.7% vs. 93,85%, p=0.002) and 9 (111.8% vs. 97,23%, p[SH1] =0.093). The anastomotic burst pressure was lower after sigmoid resection and PM on day 3 (104mmHg vs 196mmHg, p=0.017) and day 6 (204mmHg vs 211mmHg, p=0.67). While only one rat died after sigmoid resection, 7 rats (30%) died after sigmoid resection and PM (p=0.042).
Conclusion: The combination of a 25 minutes PM and sigmoid resection increases the morbidity and mortality in rats. Therefore, simultaneous resections of liver and colon should be avoided, if a Pringle` maneuvre is necessary for liver resection.