Effect of Vitamin C Supplementation on Colonic Anastomotic Healing in the Presence of Peritonitis- An Experimental Study in Rats.

ascorbic acid plays a critical role in wound repair and healing/regeneration process as it stimulates collagen synthesis. Its effect on jejunal and colonic anastomosis is already established. We assessed its role on colonic anastomosis healing in presence of peritonitis and without peritonitis. Assessment was done by recording bursting pressure of anastomosis and histological features of healing.METHODSThis experimental study was conducted in 48 Albino Rats (mean weight of 180 g). All rats were subjected to exploratory laparotomy with colonic resection anastomosis and were divided into six groups. Group A and B control, Group C and D were supplemented with Vitamin C in low dose i.e. 100 mg/Kg body, Group E and F high dose of Vitamin C i.e. 200 mg/Kg body wt. Vitamin C was given for seven days intra muscularly. Peritonitis was created by cecal ligation and puncture (CLP) in half the number of rats (n=24), in each group. Every rat was re-explored on 7th post-operative day and anastomotic segments were harvested for bursting pressure measurement and then sent for histopathology examination.RESULTSBursting Pressure of group D (100 mg) was significantly raised (p<0.05) as compared to group B in the presence of peritonitis. Group F (200 gm vit C) showed significantly higher bursting pressure than group D (p<0.05). The findings of analysis of variance (ANOVA) showed that the mean BP of all the groups differs significantly from each other (p<0.05). High dose vitamin C supplementation gave more strength to anastomosis than low dose even in presence of peritonitis. The average histopathological examination score was 5.24 (Group E) (p<0.05). i.e., best healing among all groups. It had better effect even in presence of peritonitis - 4.62 in Group F. Healing score in this group was greater than group A, B, C, D and less than in group E.CONCLUSIONSPresence of fecal peritonitis hampers the process of healing of colonic anastomosis by impairing reparative collagen synthesis, its deposition and anastomotic strength reflected by decreasedbursting pressure and decrease HPE score. Supplementation of systemic ascorbic acid increases intestinal anastomotic healing by increasing collagen accumulation reflected by increasedbursting pressure and increase HPE score even in presence of peritonitis. High dose ascorbic acid supplementation had better effect on intestinal anastomotic healing. Importance of ascorbic acid in colonic anastomosis healing is yet to be evaluated in human beings.