Determination of fibrin glue with antibiotics on collagen production in colon anastomosis

Abstract

Background/Aim. Fibrin glue is used as a matrix for local application of antibiotics. The aim of this study was to determine whether application of fibrin glue in combination with antibiotics can strengthen collagen production, prevent dehiscence of colon anastomoses due to infection, and reduce frequency of mortality and morbidity comparing to the control group and the group with fibrin glue application. Methods. The adult male Wistar rats divided into three groups were used in the experiment. The group 1 was the control one (after partial colon resection, colonic anastomoses performed were not treated), while to the group 2 and the group 3 were applied fibrin glue and fibrin glue with antibiotics (clindamycin and ceftriaxon) on the site of anastomoses, respectively. Quality of colonic anastomoses were estimated by means of determination of collagen (L-hydroxyproline) amount in the collon wall with anastomoses and histological analysis of this colon segment using light and electronic microscope on the days 5, 7 and 13 postoperatively. Results. The highest morbidity rate was registered in the group 1 (30%), then in the group 2 (13.3%) and the lowest one in the group 3 (3.33%; p < 0,05 vs group 1). Mortality rate was significantly higher in the group 1 than in the group 3 (20% and 0%, respectively; p < 0,05). In the postoperative course, the highest concentrations of collagen in the colon wall on the site of anastomoses, which was confirmed by both light and electronic microscopy, were found in the group 3. Conclusion. The application of fibrin glue with antibiotics on colon anastomoses reduces the number of dehiscence, provides good mechanical protection and shorten the time of anastomoses healing.Uvod/Cilj. Fibrinski lepak upotrebljava se kao matriks za lokalnu aplikaciju antibiotika. Cilj rada bio je da utvrdi da li primena fibrinskog lepka u kombinaciji sa antibioticima moze da pojaca produkciju kolagena, da spreci dehiscenciju anastomoze kolona nastale zbog infekcije i da smanji ucestalost mortaliteta i morbiditeta u odnosu na kontrolnu grupu i grupu sa primenom samog fibrinskog lepka. Metode. Eksperimenti su sprovedeni na odraslim muzjacima pacova Wistar soja kojima je, posle parcijalne resekcije kolona, kontinuitet creva ponovo uspostavljen izvodjenjem terminoterminalne anastomoze. Zivotinje su bile podeljene u tri grupe. Grupa 1 bila je kontrolna, grupu 2 cinile su zivotinje kod kojih je na mestu anastomoze primenjen fibrinski lepak, a grupu 3 zivotinje kod kojih je primenjen fibrinski lepak sa antibioticima (klindamicin i ceftrakson). U cilju procene kvaliteta i jacine anastomoze, petog, sedmog i 13. dana posle operacije u zidu kolona na mestu anastomoze odredjivana je koncentracija kolagena (L-hidroksiprolina) i vrsena histoloska analiza tog dela kolona pomocu svetlosnog i elektronskog mikroskopa. Rezultati. Najveca incidencija obolovenja posle izvrsenog operativnog zahvata zabelezena je u grupi 1 (30% zivotinja), zatim u grupi 2 (13,3% zivotinja), dok je najmanja registrovana u grupi 3 (3,33% zivotinja; p < 0,05 prema grupi 1). Mortalitet je bio znacajno veci u grupi 1 (20%) u odnosu na grupu 3 u kojoj nije uginula niti jedna zivotinja (p < 0,05). U postoperativnom toku, najvise koncentracije kolagena u zidu kolona na mestu anastomoze nadjene su kod zivotinja grupe 3, sto je potvrdjeno i svetlosnom i elektronskom mikroskopijom. Zakljucak. Primenom fibrinskog lepka sa antibioticima, kod izvodjenja anastomoze na kolonu, postize se manji broj dehiscencija, dobra mehanicka zastita i skracuje se vreme zarastanja anastomoza.