Ann Coloproctol.  2020 Dec;36(6):374-381. 10.3393/ac.2019.09.30.1.

Early Metabolic and Inflammatory Intraperitoneal Changes After Rectum Perforation

• Oikonomakis I
• Horer TM
• Skoog P
• Nilsson KF
• Jansson K

• KMID: 2510800
• DOI: http://doi.org/10.3393/ac.2019.09.30.1

Abstract

Purpose
Anastomotic leakage (AL) is the most dreaded complication in rectal surgery. It has a great impact on postoperative morbidity and mortality. This animal model, in which we have studied postoperative metabolic and inflammatory changes, is designed to imitate an AL.
Methods
Twelve pigs were randomized into 2 groups. In the experimental group, an iatrogenic rectal perforation was performed, with the control group having a sham operation. The 2 groups were followed for 10 hours after operation with regard to vital parameters, arterial lactate, and cytokines interleukin (IL) 1, IL6, and IL10 in the blood and intraperitoneally. Intraperitoneal microdialysis analyses of glucose, lactate, glycerol, and pyruvate were performed and the lactate/pyruvate ratio was calculated.
Results
Glucose levels were lower in the experimental group after 4 hours. After 7 hours, lactate and lactate/pyruvate ratio was higher in the experimental group. At the same time intraperitoneal cytokines IL6 and IL10 were higher in the experimental group. Blood samples showed higher IL6 after 7 hours in the experimental group. Conclusion: In this study, several significant differences between the groups in metabolic and inflammatory values were detected. Further clinical studies are recommended to evaluate the importance of intraperitoneal metabolic and inflammatory analyses as a diagnostic tool for early identification of an AL.

Keyword

Colorectal surgery; Anastomotic leak; Intraperitoneal metabolism; Intraperitoneal microdialysis; Intraperitoneal cytokines