THE CAUSES OF INTESTINAL ANASTOMOTIC LEAKAGE IN EXPERIMENTAL PERITONITIS

Abstract

Objective. To determine the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis. Methods. The experiment was carried out on non-linear white rats (n=40), divided into 4 equal groups: with peritonitis (group 1), with hypovolemia (group 2), with peritonitis in combination with hypovolemia (group 3) and comparison (group 4). Colonic “end-to-end” anastomosis was performed in all rats. Peritonitis caused by injection of 10% unfiltered feces into the abdominal cavity. Hypovolemia was modeled during the operation by creating bleeding from the branch of the iliocolic artery.The rats were taken out of the experiment on the 3rd day after the operation, the state of the anastomosis and the abdominal cavity was assessed. The histological examination of the anastomotic sites was performed. The content of hypoxia biomarkers (HIF-1a, VEGF-C, VEGF-R1) in the intestinal tissue was also evaluated by ELISA. The experiment was approved by the local ethics committee. Results. In group 1, anastomotic failure was detected in rats characterized by a severe general condition due to peritonitis. In groups 2 and 3 statistically significant relationship was found between a decrease of rectal temperature (>2 °C) due to bleeding and colonic anastomotic failure (p<0.05). Morphological analysis showed the most pronounced inflammatory and microcirculatory changes in the group 3. Statistically significant differences in the level of the VEGF-C (p=0.0034) and VEGF-R1 (p=0.04795) were found between groups. Maximal ischemia of the anastomotic zone was found in rats of group 3. Conclusion. The leading factor in the pathogenesis of intestinal anastomotic failure is considered to be as a result of impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow. Monitoring and successful correction of hemodynamic disturbances in the perioperative period may become a prospect for the treatment of patients with peritonitis requiring intestinal anastomosis under these conditions. What this paper adds For the first time determination of the leading factor in the pathogenesis of intestinal anastomotic failure in peritonitis has been studied. The leading factor in the pathogenesis of intestinal anastomotic failure has been found out to be the impairedblood supply of the anastomotic zone due to hypovolemia and depletion of mesenteric blood flow.