Abstracts
2000 Digestive Disease Week

# 2286 The Influence of Diabetes on the Strength of Abdominal Wall Repair in the Rat.
Ram M. Spira, Aviram Nissan, Efrat Levine-Blum, Ehud Ziv, Dan Seror, Hanoch Bar-On, Herbert R. Freund, Jerusalem, Israel

Background: The influence diabetes on wound healing has been a matter of controversy. The need for tight control of glycemia during the perioperative period has not been established. Methods: Diabetes was induced in 27 male Sabra rats by streptozotocin injection. Once hyperglycemia was established, the rats were randomly divided into two groups: Insulin treated group (A) and an untreated diabetic group (B). 12 non-diabetic rats served as a control group (C). Normoglycemia was maintained by measuring glucose blood levels and injecting insulin twice daily. On the 11th day following induction of diabetes the animals were anesthetized and a standard 4.0x0.5cm midline abdominal defect was created and repaired using a nylon suture material. On the 41st day following induction of diabetes the animals were sacrificed, the entire abdominal wall removed and placed over a bursting pressure device specifically built for this purpose, in which the pressure inside the chamber corresponds directly to the tensile forces acting on the abdominal wall. The pressure inside the chamber was gradually increased until disruption of the wound occurred. Results: The average glucose level of the insulin treated group (A) was 270±5mg/dl, and 412±70 mg/dL for the untreated diabetics (B). Fructosamine was significantly higher in group B 3.48±0.16 mmol/l than in groups A (2.43±0.07 mmol/l) and C (2.03±0.09 mmol/l). The insulin blood levels were significantly lower in the untreated diabetic (B) 16.4±1.9 mU/L compared to group A: 93±14.3 mU/L and group C: 78.4±10.0 mU/L. Both the treated diabetics and controls gained weight throughout the experiment (A/C from 275±7/274±9g to 342±11/360±8g) in contrast to the untreated diabetics, which lost weight (from 248±6g to 223±13g). The bursting pressures for the insulin treated group A 1.26±0.07 kg/cm2 were similar to the control group C 1.27±0.09 kg/cm2 and significantly higher compared to the untreated diabetic group B 0.60±0.08 kg/cm2, (p<0.001). Conclusions: Diabetes impairs the strength of abdominal wound healing in the rat. The perioperative control of glycemia, even if not performed to strict normoglycemia, prevents diabetes-induced wound healing impairment and maintains abdominal wall wounds bursting pressure at normal levels.