Abstracts
1998 Digestive Disease Week
#1068
EFFECT OF NUTRITIONAL ROUTE ON COLONIC ANASTOMOTIC HEALING IN THE RAT. T. Kiyama, D. T. Efron, U. Tantry, A. Barbul. Dept Surgery, Sinai Hospital & The Johns Hopkins Medical Institutions, Baltimore, MD.
Enteral nutrition (ENT) has been shown to enhance survival rate and decrease septic complications when compared to parenteral nutrition (TPN). Although early ENT was shown to benefit cutaneous healing, the effect of the route of nutritional support in GI anastomotic healing has not been defined. The aim of the present study was to determine whether the route of nutritional support influences colon anastomotic healing.
Seventeen male Sprague Dawley rats, 270-290g BW, underwent identical surgical manipulation consisting of central venous catheterization, insertion of gastrostomy and distal colon anastomosis (single-layer, inverted). Identical infusates of 4.25% amino acids, 25% dextrose, and vitamins were administered, half the animals receiving the infusions via the gastrostomy and the other half via the venous catheter. Animals were sacrificed 5 days post-surgery. Colon bursting pressure (CBP-mm Hg), anastomotic hydroxyproline content in both soluble and insoluble collagen fractions (OHP-µg/mg wet tissue) and _-amino nitrogen (AAN-µmol/mg wet tissue) were measured.
There were no differences in nutritional parameters between the TPN and ENT groups in terms of energy intake (50.8 ± 1.5 vs 50.7 ± 1 kcal/day), body weight gain (9.6 ± 2.7 vs 5.4 ± 3.2g/5days) and plasma levels of albumin, total protein, glucose or BUN.
|
|
n
|
CBP
|
OHP
(insoluble)
|
OHP
(soluble)
|
AAN
|
ENT
|
10
|
180 ± 6*
|
1.91 ± 0.09
|
0.79 ± 0.04
|
61.7 ± 1.3
|
TPN
|
7
|
150 ± 11
|
1.62 ± 0.13*
|
0.90 ± 0.08
|
54.9 ± 4.0*
|
Data mean ± SEM; *p < .05 Student's t-test,
Colon anastomotic bursting pressure was significantly higher in the ENT group. This was paralleled by enhanced insoluble collagen and total protein (AAN) content in the anastomosis. The soluble, newly synthesized collagen fraction did not differ among groups.
The data demonstrate that colonic anastomotic healing is influenced by the route of nutritional administration. The preservation of colonic structural collagen in the ENT group may improve the ability of the gut to hold sutures and thus enhance anastomotic healing.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
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