CIRCULAR MUSCLE INCISION PERFORMED IN SIDE-TO-SIDE BOWEL ANASTOMOSIS CAUSES RETENTION OF INTESTINAL CONTENTS
Toru Kono*1,2, Kunitsugu Kubota3, Atsushi Takata1, Jun Higashijima1, Yuji Morine1, Mitsuo Shimada1
1Department of Digestive and Pediatric Surgery, Tokushima University Graduate School, Tokushima, Japan; 2Center for Clinical and Biomedical Research, Sapporo Higashi Tokushukai Hospital, Hokkaido, Japan; 3Tsumura Kampo Research Laboratories, Tsumura & Co., Ibaraki, Japan
Background and Aim:
Surgical recurrence, resulting from anastomotic site recurrence following intestinal resection, develops frequently despite advances in internal medicine. While the underlying cause is unknown, the involvement of intestinal bacteria has been strongly suggested. We hypothesized that because anastomotic site recurrence tends to occur at the anastomotic site and oral side, the retention of intestinal contents, due to decreased intestinal motor function at the anastomotic site, is a factor for recurrence aggravation. We then evaluated intestinal motor function and transportation ability based on anastomosis.
Methods:
Isolated rat proximal colon segments were placed in 35-37°C aerated Krebs solution. For surgical treatment, a long axis incision of 1 cm was made in the intestinal tract. Segments were then divided into a group that had the long axis incision sutured and a group that did not, and each parameter was compared between the groups. Intestinal motility was evaluated based on changes in intraluminal pressure. To evaluate intestinal transit, we measured the transit time of plastic beads, 5.9 mm in diameter, from the oral side to anal side in proximal colon. To investigate intestinal motility and transit, we induced propulsive movement by administering hydroxy-α-sanshool (HAS) 10 μmol/L, a prokinetic agent that has also been reported at DDW, into the serous membrane side (Krebs solution).
Results:
Slight stenosis was observed at the site underwent surgery in proximal colon. When HAS was added to the serous membrane side, this induced propulsive contractions similar to strong, rhythmical wringing out motions. Bead transit time in the proximal colon, when HAS was added, was prolonged by surgical treatment (non-treatment group: 20.0±1.5 min; operation group: 44.5±2.9 min). The intraluminal pressure elevation peak amplitude, accompanying contractions of the proximal colon brought about by HAS, decreased with surgical treatment (non-treatment group: 80.8±3.9 mmHg; operation group: 40.7±6.0 mmHg) and the area under the curve for this also decreased (non-treatment group: 9401±1069; operation group: 6928±612).
Conclusions:
Our experiment showed that long axis incision (circular muscle incision) of the intestinal tract decreased the intestinal lumen contraction force and caused retention and attenuated the movement of intestinal contents. The results suggested that maintaining transit of the anastomotic site in intestinal tract might be important in decreasing the incidence of anastomotic site recurrence following surgical treatment for Crohn's disease and preventing surgical recurrence.
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