The effects of scalpel, harmonic scalpel and monopolar electrocautery on the healing of colonic anastomosis after colonic resection

PURPOSE: In our study, the effects of harmonic scalpel, scalpel, and monopolar electrocautery usage on the health and healing of colon anastomosis after resection was investigated. METHODS: In this study, 120 female albino Wistar rats were divided into 3 groups each containing 40 rats. Group A, resection with scalpel; group B, resection with monopolar electrocautery; group C, resection with harmonic scalpel. The groups were divided into 4 subgroups consisting of 10 rats and analysed in the postoperative 1st, 3rd, 5th, and 7th days. Anastomotic bursting pressures, hydroxyproline levels and histopathological parameters were surrogate parameters for evaluating wound healing. RESULTS: The tissue hydroxyproline levels did not show any significant difference between the groups and subgroups. The mean bursting pressure of group A on the 5th day was significantly higher than groups B and C (P < 0.001). When the fibroblast and fibrosis scores were evaluated, scores of group C on the 5th day were significantly higher than the other groups, but the results of bursting pressures and biochemical parameters did not support the fibroblast and fibrosis scores. There were not any significant differences between the groups in other histopathologic parameters. CONCLUSION: The use of monopolar electrocautery needs more attention since the device causes tissue destruction. The obliterating effect of harmonic scalpel on luminal organs is an important problem, especially if an anastomosis is planned. Despite the disadvantages of scalpel, its efficacy on early wound healing is better than the other devices.

Prevention of Anastomotic Leakage in Gastrointestinal Tract: A Brief Literature Review.

Anastomotic leakage and its consequences in gastrointestinal tract surgery, especially in low anterior resection, is a day major complication affecting morbidity and mortality rate. Early detection and prevention is crucial in order for sepsis to be avoided. There are well-defined risk factors influencing anastomosis healing. The patient’s status and operative conditions including surgical technique have been incriminated for dehiscence. The correct application of conventional operative principles is important. The outcome of anastomosis either handsewn or stapled is deemed to have no major difference. Novel compression anastomotic instruments have been proposed as an alternative option, yet without wide broad application and enough experience. There are innovative staple line reinforcement materials. Some topics such as proximal defunctioning stoma, pelvic tubes or the recently proposed transanal drainage tube are in debate for routine or selective use. Protective transverse colostomy does not affect the risk of leakage, but it reduces the septic consequences. Laparoscopic procedures have similar anastomotic leakage rate with open operations. There is no consensus on whether covering anastomosis with great omentum is necessary as protection or for mechanical bowel preparation. Novel promising perspectives exist as well as commonly accepted aspects. The combination of conventional techniques (handsewn or stapled anastomosis performance) with modern techniques may be proved effective in reducing anastomotic leakage rates.

The effects of ghrelin on colonic anastomosis healing in rats

OBJECTIVES: In addition to its roles in the stimulation of growth hormone secretion and the regulation of appetite and metabolism, ghrelin exerts immunomodulatory, anti-inflammatory and antioxidant actions in several organ systems. In this study, we investigated the effects of ghrelin on the healing of experimental colonic anastomoses. METHODS: Wistar rats were randomly divided into two groups (n = 10 in each). A segment of colon was excised, and an end-to-end anastomosis was performed in the distal colon. The Ghrelin Group received 10 ng/kg/day IP ghrelin for seven days postoperatively, whereas the Control Group received an identical volume of saline. On the seventh postoperative day, the anastomotic bursting pressures and hydroxyproline levels were measured, and adhesion formation around the anastomoses was examined. Histopathological analyses were performed to evaluate inflammatory cell infiltration, fibroblast infiltration, collagen density and neovascularization. RESULTS: In the Ghrelin Group, the bursting pressure and hydroxyproline levels were significantly higher than in the Control Group. The adhesion formation scores were lower in the Ghrelin Group than in the Control Group. Although the inflammatory cell infiltration was diminished in the Ghrelin Group, the degrees of fibroblast infiltration, collagen density and neovascularization were not significantly different between the groups. CONCLUSION: Our results indicate that ghrelin improves the healing of colonic anastomoses in rats.