A New Anastomotic Leakage Model in Circular Double Stapled Colorectal Anastomosis After Low Anterior Rectum Resection in Pigs. (1st December 2013)

• Record Type: Journal Article
• Authors: Wenger, F. A.; Szucsik, E.; Hoinoiu, B. F.; Ionac, M.; Walz, M. K.; Schmid, K. W.; Reis, H.
• Is Part Of: Journal of investigative surgery. Volume 26:Number 6(2013:Dec.)
• Page Start: 364
• Page End: 372
• Publication Date: 2013-12-01
• Subjects: anastomotic leakage -- low anterior rectum resection -- pigs -- circular double-stapled anastomosis -- histology; Surgery -- Research -- Periodicals; Research; Surgery; Surgical Procedures, Operative; 617.075
• DOI: 10.3109/08941939.2013.818174
• Languages: English
• ISSNs: 0894-1939

Abstract

ABSTRACT: Background : A high incidence of anastomotic leakage (37.5%) is reported after low anterior rectal resection (LAR) and circular double-stapled anastomosis without protective ileostoma. Since the pathomechanism of anastomosis leakage is still unclear, a suitable animal model would be most desirable. Methods : The objective was to assess the incidence of clinically apparent and inapparent leakage after LAR in pigs ( n = 20). Endpoints were radiological, clinical, macroscopic, and histologic proof of anastomotic leakage on the 9th postoperative day. Integrity of anastomosis was assessed by double-contrast barium examination on 9th postoperative day. Animals were sacrificed and anastomoses were resected for histopathological investigation. In case of earlier clinical apparent anastomotic leakage, radiologic double-contrast barium was performed immediately. Results : LAR with a circular double-stapled anastomosis without protective ileostoma was performed in 20 pigs (m:f = 8:12). Length of resection was 10–20 cm, anastomosis was performed 7 cm ab ano. Five animals (25%) developed clinical apparent anastomotic leakage (no appetite, fever, inactivity, tachypnea, discomfort, pain) between the 6th ( n = 1) and 9th ( n = 4) postoperative day, proven by double-contrast barium radiographs. Additionally in 1 animal clinical inapparent anastomotic insufficiency was observed radiologically. Total rate of leakage was 30% ( n = 6). These results were confirmed by leucocytosis, low potassium levels, in two cases high ALT and AST and local peritonitis in all cases. Conclusion : Including one additional case of clinical inapparent leakage, total rate of anastomotic leakage was 30% (6/20). Thus we managed to establish a new experimental model of anastomotic leakage after low rectal resection comparable to the human situation.