Intraoperative crystalloid overload leads to substantial inflammatory infiltration of intestinal anastomoses—a histomorphological analysis

• Published in: Surgery Vol. 154; no. 3; pp. 596 - 603
• Main Authors: Kulemann, Birte, MD, Timme, Sylvia, MD, Seifert, Gabriel, MD, Holzner, Philipp A., MD, Glatz, Torben, MD, Sick, Olivia, MSc, Chikhladze, Sophia, MD, Bronsert, Peter, MD, Hoeppner, Jens, MD, Werner, Martin, MD, Hopt, Ulrich T., MD, Marjanovic, Goran, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2013
• Subjects: Anastomosis, Surgical; Animals; Collagen - analysis; Immunohistochemistry; Inflammation - pathology; Intestines - pathology; Intestines - surgery; Isotonic Solutions - administration & dosage; Leukocytes - physiology; Macrophages - physiology; Male; Matrix Metalloproteinase 13 - analysis; Matrix Metalloproteinase 2 - analysis; Rats; Rats, Wistar; Surgery; Wound Healing
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2013.04.010

Background It has been shown that crystalloid fluid-overload promotes anastomotic instability. As physiologic anastomotic healing requires the sequential infiltration of different cells, we hypothesized this to be altered by liberal fluid regimes and performed a histomorphological analysis. Methods 36 Wistar rats were randomized into 4 groups (n=8-10 rats/group) and treated with either liberal (+) or restrictive (−) perioperative crystalline (Jonosteril® = Cry) or colloidal fluid (Voluven® = Col). Anastomotic samples were obtained on postoperative day 4, routinely stained and histophathologically reviewed. Anastomotic healing was assessed using a semiquantitative score, assessing inflammatory cells, anastomotic repair and collagenase activity. Results Overall, the crystalloid overload group (Cry (+)) showed the worst healing score ( P < 0.01). A substantial increase of lymphocytes and macrophages was found in this group compared to the other three ( P < 0.01). Both groups that received colloidal fluid (Col (+) and Col (−)) as well as the group that received restricted crystalloid fluid resuscitation (Cry (−)) had better intestinal healing. Collagenase activity was significantly higher in the Cry (+) group. Conclusion Intraoperative infusion of high-volume crystalloid fluid leads to a pathological anastomotic inflammatory response with a marked infiltration of leukocytes and macrophages resulting in accelerated collagenolysis.