The prevention of leakage of ileo-colonic anastomosis in an experimental peritonitis

Introduction. In colon surgery, intestinal anastomotic leaks are the main contributor to postoperative mortality. The incidence of this complication in the formation of small-colonic anastomoses in urgent surgery reaches 12% or more. It is required to develop simple and reliable techniques of intestinal suturing in conditions of peritonitis.
The aim of the study was to investigate the morphological events occurring in the small-colonic anastomosis formed using various options under simulated peritonitis.
Materials and methods. An experimental study involved 2 groups of Wistar white rats (25 animals - the control group and 25 - the main one). Peritonitis was simulated by dissecting the ileum into ¼ circles in 5-6 cm from the ileocecal angle. A day later, a relaparotomy was performed, a section of the intestine with a defect was excised, the distal loop was tied up, a small-colonic anastomosis was formed with a proximal loop: in “the end-to-side” study group the intervention was performed according to the author's method (RF patent No. 2709253 dated 12/17/2019), in the control group – using side-to-side anastomosis. In 6 days, anastomosis was taken from the survived animals for histological examination. Histological examination was carried out at a magnification x400 and x630. Micromorphometry was performed with the count of neutrophils, fibroblasts and measurement of the relative area of ​​blood vessels in the anastomotic suture. Fisher's exact test, Mann-Whitney test were used for statistical data processing, quantitative data were described in the median and interquartile interval format.
Results. An original end-to-side anastomosis resulted in a greater number of fibroblasts and blood vessels in the muscular and submucosal layers of the intestinal wall in the suture zone than in the side-to-side anastomosis. The number of anastomotic leaks in the study group was 4 times less than in the control group.
Conclusion. The use of the authors’ end-to-side anastomosis technique improves blood supply and repair of the suture area in a small-colonic anastomosis under 1-day simulated peritonitis; this being accompanied by a decreased incidence of anastomosis failure.