Effect of intraoperative nutritional solutions on perianastomotic colonic mucosa in experimental large bowel obstruction.

We investigated the effect of intraoperative lavage with various solutions on the morphology of the mucosa adjacent to the anastomosis performed in left-sided colonic obstruction. After 24 hr of ligature obstruction to the pelvic colon, 108 male Wistar rats underwent colonic resection followed by primary anastomosis and were randomized for lavage with one of four different solutions: saline, povidone-iodine, 10% hypertonic glucose (HG), and short-chain fatty acids (SCFA). A control group had no lavage. The anastomotic region was studied both macroscopically and with light microscopy after three or six days. At day 3, lavaged animals, especially those with SCFA, had significantly smaller ulcers than controls, and at day 6 only rats lavaged with SCFA and HG were free of large ulcers. At day 3, median (interquartile range) crypt depth was higher in SCFA [360 (286-374) microm] and HG animals [306 (279-315) microm] when compared with controls [243 (225-252) microm; P < 0.05], and SCFA [67 (53-89)] rats showed more cells per crypt than controls [48 (39-52); P < 0.05]. No differences occurred on the sixth day. We conclude that intraoperative lavage with nutrient solutions, particularly with SCFA, has a trophic effect on the colonic mucosa. The suture line gap in the mucosa may be filled more quickly, thus contributing to improve the healing of a colonic anastomosis.