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Loss of colonic structural collagen impairs healing during intra-abdominal sepsis
G M Ahrendt1, K Gardner, A Barbul
1Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
Objective:
To investigate colon anastomotic healing in an experimental model of sepsis.
Design:
Prospective, randomized, experimental trial.
Setting:
Experimental surgical laboratory of a large community hospital.
Study Participants:
Twenty-eight male Sprague-Dawley rats weighing 310 to 380 g.
Interventions:
On day 0, the rats underwent either sham laparotomy or cecal ligation and puncture. The next day, the rats underwent left colon resection and single-layer inverted anastomosis. Colon-bursting pressure was determined 5 days after surgery at which time the anastomosis and a segment of colon 3 cm proximal to the anastomosis were excised.
Main Outcome Measures:
Colon-bursting pressure, colonic hydroxyproline concentration (index of collagen content), and total protein concentration measured as alpha-amino nitrogen.
Results:
Sepsis resulted in decreased anastomotic bursting pressure and collagen concentration in all colon segments that were analyzed in the animals that underwent cecal ligation and puncture compared with control animals.
Conclusions:
Sepsis impairs healing of the colon, reflected by decreased bursting pressure and collagen concentration. The decrease in bowel wall structural collagen may affect the ability of the gut to hold sutures and thus may lead to more anastomotic failure.