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ABSTRACT: A standardized stenosis of the left colon was created in the rat model. After four days the stenosis was resected and a primary anastomosis made. Half of the animals (n = 21) were randomized to a proximal diverting colostomy and the other half to a non-colostomy control group. On postoperative days two and seven anastomotic complications were recorded and anastomotic strength was determined. Collagen content in the anastomotic area was measured. In the colostomy group no anastomotic complications occurred, while 6/21 (29%) animals in the non-colostomy group had complications. On day two there was no difference between the groups as regards anastomotic strength and collagen content. After a week, however, the control group showed a significant increase in both anastomotic strength and collagen content which was not observed in the colostomy group. The absence of increase in anastomotic strength in the colostomy group had no adverse effect on anastomotic healing, as judged by complications. Thus, a diverting colostomy may be of value in reducing anastomotic complications after resection of a left colon obstruction.
International Journal of Colorectal Disease 09/1990; 5(3):167-9. · 2.38 Impact Factor
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ABSTRACT: The influence of bacteria on metabolism of collagen in the colonic wall under normal conditions and after obstruction was evaluated by using germ-free and conventionally bred rats. Under normal conditions, no differences in synthesis and content of collagen or tissue dry weight in the colonic wall were found between germ-free and conventionally bred rats. After obstruction, both groups reacted similarly with an equally increased collagen synthesis. The findings imply that bacteria do not play any major role in the regulation of collagen metabolism in the colonic wall, neither under normal conditions nor in the strained situation with colonic obstruction and fecal impaction.
Surgery, gynecology & obstetrics 08/1990; 171(1):5-8.
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ABSTRACT: Anastomotic breaking strength and collagen metabolism in the colonic wall were studied after resection of a standardized left-colon stenosis in the rat. An increased complication rate was found in the stenosis group compared with the control group (27 percent vs. 2 percent) and the complications arise soon after surgery. The collagen turnover in the anastomotic area, as well as the changes of breaking strength, were equal between the groups in the early healing course, implying that the stenosis group, as an entity, did not show impairment in the studied parameters predisposing for complications. Other factors such as mechanical strain by the increased fecal bulk and increased bacterial load may contribute to occurrence of the anastomotic complications.
Diseases of the Colon & Rectum 04/1990; 33(3):217-21. · 3.13 Impact Factor
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ABSTRACT: A standardized stenosis of the left colon was created in the rat model. After four days the stenosis was resected and a primary anastomosis made. Half of the animals (n=21) were randomized to a proximal diverting colostomy and the other half to a non-colostomy control group. On postoperative days two and seven anastomotic complications were recorded and anastomotic strength was determined. Collagen content in the anastomotic area was measured. In the colostomy group no anastomotic complications occurred, while 6/21 (29%) animals in the non-colostomy group had complications. On day two there was no difference between the groups as regards anastomotic strength and collagen content. After a week, however, the control group showed a significant increase in both anastomotic strength and collagen content which was not observed in the colostomy group. The absence of increase in anastomotic strength in the colostomy group had no adverse effect on anastomotic healing, as judged by complications. Thus, a diverting colostomy may be of value in reducing anastomotic complications after resection of a left colon obstruction.
International Journal of Colorectal Disease 01/1990; 5(3):167-169. · 2.38 Impact Factor
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ABSTRACT: The influence of long-term relative bowel rest, using a low residue diet, on healing of a left colon anastomosis was experimentally studied. Retarded and diminished gain of postoperative anastomotic collagen and strength was found. The healing of the anastomosis was uncomplicated, however, and it is concluded that anastomotic integrity after surgery in this condition is safe.
Diseases of the Colon & Rectum 12/1988; 31(11):886-91. · 3.13 Impact Factor
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ABSTRACT: Collagen content, bursting wall tension, and suture-holding capacity in the proximal and distal colon of the rat were studied after long-term treatment with a low-residue or a standard laboratory chow diet. Collagen content decreased uniformly in both the proximal and distal colon of the low-residue diet group. In addition, the bursting wall tension of the nonoperated proximal colon was reduced, whereas the breaking strength of a newly constructed anastomosis at three different colonic sites was unaffected.
The American Journal of Surgery 12/1988; 156(5):381-5. · 2.78 Impact Factor
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ABSTRACT: The healing of an experimental left colon anastomosis protected by a proximal diverting colostomy was studied in the rat. Collagen synthesis in the anastomotic area was measured by incorporation of [3H]proline. With a defunctioning proximal colostomy, the synthesis and accumulation of collagen in the anastomosis was diminished, and the anastomotic strength development delayed and reduced. The development of anastomotic strength seems to proceed according to the level of strain from intraluminal bulk. As the healing of the anastomosis protected by a diverting colostomy was uncomplicated, these findings should not contra-indicate the use of diverting colostomy.
British Journal of Surgery 05/1988; 75(4):325-9. · 4.61 Impact Factor
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ABSTRACT: The healing of a standardized left colon anastomosis after early (7 days) closure of a concomitant proximal diverting colostomy was studied experimentally. Early closure of the diverting colostomy could be conducted safely by an intraperitoneal technique and the healing of the primary anastomosis was uncomplicated. Colostomy closure in the proliferative phase of wound healing resulted in development of anastomotic strength similar to colonic healing without faecal diversion. The anastomotic strength had doubled after three weeks. As compared to colostomy closure in the remodelling phase of anastomotic healing development of anastomotic strength was more rapid and without serious local complications.
International Journal of Colorectal Disease 04/1988; 3(1):59-64. · 2.38 Impact Factor
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ABSTRACT: The impact of colostomy closure on the healing of a left colonic anastomosis performed 4 weeks earlier was studied in rats. Colostomy closure could be safely accomplished but in 3 of 25 rats was followed by faecal obstruction due to narrowing of the primary left colonic anastomosis. After colostomy closure the gain in anastomotic strength was slow and did not exceed the outset value until after 3 weeks. After colostomy closure, accumulation of collagen in the anastomotic region increased earlier than anastomotic strength, indicating delay in collagen maturation.
Acta chirurgica Scandinavica 03/1988; 154(2):127-32.
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ABSTRACT: The healing of a standardized left colon anastomosis after early (7 days) closure of a concomitant proximal diverting colostomy was studied experimentally. Early closure of the diverting colostomy could be conducted safely by an intraperitoneal technique and the healing of the primary anastomosis was uncomplicated. Colostomy closure in the proliferative phase of wound healing resulted in development of anastomotic strength similar to colonic healing without faecal diversion. The anastomotic strength had doubled after three weeks. As compared to colostomy closure in the remodelling phase of anastomotic healing development of anastomotic strength was more rapid and without serious local complications.
International Journal of Colorectal Disease 02/1988; 3(1):59-64. · 2.38 Impact Factor
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ABSTRACT: The influence of standard heparin or low molecular weight (LMW) heparin on healing of abdominal wounds and colonic anastomoses was studied in rats. Subcutaneous injection of 1 XaI U/g b.w. of standard or LMW-heparin or 0.5 ml physiologic saline was given 12 hours preoperatively and daily for 3 or 7 days postoperatively. Breaking strength of the abdominal wound and the anastomosis was measured, as were haemoglobin and albumin in serum. Hydroxyproline as a measure of collagen and tissue dry weight was determined in standardized segments of colonic wall adjacent to the anastomosis. Except for significant increase in breaking strength of the anastomosis after 7-day injection of LMW heparin, no differences in the parameters of wound healing were found after 3 or 7 days. In rats receiving standard heparin there was increased bleeding tendency (reduced haemoglobin) compared with the LMW-heparin group and the controls. The administered heparin thus did not negatively influence healing, and standard and LMW-heparin did not differ in this respect.
Acta chirurgica Scandinavica 11/1987; 153(10):593-8.
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British Journal of Surgery 06/1986; 73(5):415. · 4.61 Impact Factor
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ABSTRACT: In the present investigation, the effect of a proximal diverting colostomy on suture holding capacity and on anastomotic strength of the excluded left colon was studied. Suture holding capacity was increased 7 days after fecal diversion. Anastomotic strength development, however, was significantly delayed. These differences were accompanied by a diminished collagen response in the anastomotic region after fecal diversion. This might suggest impairment of healing in the excluded colon. The gross appearance of the anastomoses would, however, indicate that increased collagen formation and greater strength development in animals without colostomy is a result of more complicated healing.
The American Journal of Surgery 07/1985; 149(6):712-5. · 2.78 Impact Factor
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ABSTRACT: The effect of total bowel rest by colostomy on collagen metabolism was studied. Fecal diversion led to a marked decrease of collagen and protein synthesis in the excluded colon. These changes were accompanied by a decrease in the amount of collagen and noncollagenous components. In the colonic part proximal to the colostomy site, a less marked decrease in collagen content was observed. It was concluded that stimulation of intraluminal bulk might be important as a regulating factor for collagen turnover. It remains to be determined if the observed changes in collagen metabolism affect colonic healing.
The American Journal of Surgery 04/1985; 149(3):330-3. · 2.78 Impact Factor
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ABSTRACT: Collagen metabolism was studied in the colonic wall of rats after standardized resection and anastomosis. Diminished faecal loading was obtained by feeding rats low-residue diet (Bisorbin MCT). The postoperative increase of collagen synthesis and collagen content was on a lower level in these rats than in rats on standard laboratory diet. The increase was confined to the immediate anastomotic region and presumably represented changes in collagen caused by the operative trauma per se. It was concluded that the intraluminal content is an important factor in stimulating collagen turnover. The findings of lower collagen turnover in the anastomotic area in animals on low-residue diet may have positive significance, but could also imply impairment of healing. For elucidation of this question, studies on mechanical strength of the anastomosis are necessary.
Acta chirurgica Scandinavica 02/1984; 150(8):677-81.
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ABSTRACT: The breaking strength of anastomoses in the left colon in the early phase of healing was studied in rats fed low residue diet (Biosorbin MCT) and the results were compared to those from rats fed standard laboratory diet. Further, eventual correlation between mechanical strength development and collagen content in the colonic wall around the anastomosis was evaluated. The anastomotic strength with sutures in place decreased by approximately 30% of the immediate postoperative value during the first two days in both groups of animals. There was no correlation between changes in anastomotic strength and collagen content at that time. After the second day there was a gradual increase of anastomotic strength, reaching the strength at day 0 after 7 days. The regain of strength was mainly due to collagen deposition in the anastomosis. Despite more collagen deposition in animals on standard laboratory diet the anastomoses had comparable strength development in the two groups. It was concluded that low residue diet does not impair the suture holding capacity or the anastomotic strength. Instead there was some evidence for a more uncomplicated healing when the bowel content was diminished.
Acta chirurgica Scandinavica 02/1984; 150(8):671-5.
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ABSTRACT: In a previous experimental study it was shown that bowel rest with low residue diet led to a reduction of the non-collagenous substances in the intact, unoperated colon, while the collagen content remained unchanged. In the cecum, both the collagen content and the non-collagenous substances were markedly increased. In the present investigation the effect of relative bowel rest on collagen synthesis in the colonic wall was studied. Further, a possible influence on mechanical properties was evaluated. It was found out that bowel rest led to a marked decrease of collagen and protein synthesis in the colon. In the cecum, there was an unchanged collagen synthesis but an increased protein synthesis. It can be deduced that lysis of collagen is decreased in all parts of the colon. The depression of collagen turnover in the colonic wall was not accompanied by measurable changes in mechanical strength. It remains to be studied whether the observed changes in collagen metabolism do affect colonic healing.
Research in Experimental Medicine 02/1984; 184(4):221-6.
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ABSTRACT: In previous studies it was shown that diminished colonic content pre- and postoperatively, obtained by feeding rats low residue diet, results in less marked postoperative disturbances in collagen metabolism than in animals fed standard laboratory diet. In the present investigation the effect of relative bowel rest on collagen content and collagen concentration in the intact colonic wall was studied by feeding unoperated rats low residue diet. It was found that the colonic and cecal contents were reduced significantly and that this primarily affected the non-collagenous substances in the colon with a marked decrease, while the collagen content was unchanged. In the cecum, both the collagen and the non-collagenous contents were significantly increased. Thus, the pattern of change in biochemical response varied in different parts of the large intestine after institution of bowel rest. Further, the present data imply that collagen concentration can be misleading as a measure of the actual collagen amount.
Research in Experimental Medicine 02/1984; 184(3):151-8.
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ABSTRACT: The influence of colonic stenosis resulting in faecal loading was investigated in regard to collagen metabolism in the intact colonic wall. The collagen content was increased in the left colon proximal to the stenosis, due to enhanced collagen synthesis. The collagen concentration fell significantly, however, as noncollagenous substances increased more than collagen. Collagen concentration clearly can be misleading as an indication of the actual amount of collagen. The enhanced rate of collagen turnover with collagen accumulation proximal to stenosis requires further analysis in regard to its importance for healing capacity.
Acta chirurgica Scandinavica 154(5-6):389-93.
