Ulus Travma Acil Cerrahi Derg. 2023; 29(9): 956-962 | DOI: 10.14744/tjtes.2023.86579

The comparison of the suture materials on intestinal anastomotic healing: an experimental study

Osman Uzunlu¹, Emrah Aydýn², Erdem Çomut³, Esin Avcý⁴, Hande Þenol^5
1Department of Pediatric Surgery, Pamukkale University, School of Medicine, Denizli-Türkiye
²Department of Pediatric Surgery, Namýk Kemal University, School of Medicine, Tekirdað-Türkiye
³Department of Pathology, Pamukkale University, School of Medicine, Denizli-Türkiye
⁴Department of Biochemistry, Pamukkale University, School of Medicine, Denizli-Türkiye
⁵Department of Statistics, Pamukkale University, School of Medicine, Denizli-Türkiye

BACKGROUND: This experimental comparative study was to evaluate the local effects of three different suture materials on in-testinal anastomosis healing.
METHODS: Ethical approval was obtained from the University of Ethical Committee (E-60758568-020-176720). A prospective, experimental comparative analysis was conducted on 24 rats. They were divided into three equal groups; Group 1 underwent colonic anastomosis with Vicryl suture material, Group 2 underwent colonic anastomosis with polypropylene suture; and Group 3 underwent colonic anastomosis with polydioxanone (PDS) suture. The second operation underwent the 7th post-operative day. Adhesion score, anastomotic leakage, anastomotic bursting pressure, hydroxyproline levels, and histopathologic examination were evaluated.
RESULTS: All animals survived, and no leakage, intestinal obstruction, or wound infection was observed during the experiment. The adhesion score was evaluated according to the Diamond classification and same in all groups. Median anastomotic bursting pressure was 125.75 mmHg (10–241) in the Vicryl group, 159.25 mmHg (113–190) in the polypropylene group, and 154.50 mmHg (20–212) in the PDS group. Hydroxyproline tissue concentrations were in the Vicryl group 1699.92±220.8 ng/mg (range: 1509.81–2186.47), in the polypropylene group 1126.24±607.12 ng/mg (range: 53.22–1815.63), and 1547.86±335.2 ng/mg (range: 973.66–1973.2) in PDS group. There was no difference among groups regarding the inflammatory response evaluated by histopathology. There was no statistical significance in all variables evaluated.
CONCLUSION: This experimental study demonstrates that suture materials did not worsen tissue healing during intestinal anastomosis. Absorbable, slowly-absorbable, and non-absorbable suture materials could be used safely in every situation.

Keywords: Anastomotic healing, anastomotic leak; animal experiments; surgical anastomosis; suture techniques.

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Farklý dikiþ materyallerinin baðýrsak anastomoz iyileþmesi üzerine etkileri: Deneysel bir çalýþma

Osman Uzunlu¹, Emrah Aydýn², Erdem Çomut³, Esin Avcý⁴, Hande Þenol^5
1Pamukkale Üniversitesi Týp Fakültesi Çocuk Cerrahisi Anabilim Dalý, Denizli, Türkiye
²Namýk Kemal Üniversitesi Týp Fakültesi Çocuk Cerrahisi Anabilim Dalý, Tekirdað, Türkiye
³Pamukkale Üniversitesi Týp Fakültesi Patoloji Anabilim Dalý, Denizli, Türkiye
⁴Pamukkale Üniversitesi Týp Fakültesi Biyokimya Anabilim Dalý, Denizli, Türkiye
⁵Pamukkale Üniversitesi Týp Fakültesi Biyoistatistik Anabilim Dalý, Denizli, Türkiye

AMAÇ: Deneysel ve karþýlaþtýrmalý çalýþmada, üç farklý dikiþ materyalinin intestinal anastomoz iyileþmesi üzerindeki lokal etkilerinin deðerlendirilmesi amaçlanmýþtýr.
GEREÇ VE YÖNTEM: Üniversite Etik Kurulu'nun (E-60758568-020-176720) etik onayý alýndýktan sonra çalýþmaya baþlandý. 24 sýçan üzerinde prospektif, deneysel bir karþýlaþtýrmalý analiz yapýldý. Denekler üç eþit gruba ayrýldýlar; Grup 1'e vikril dikiþ materyali ile kolon anastomozu yapýldý, Grup 2; polipropilen dikiþle kolonik anastomoz yapýldý ve Grup 3’e; polidioksanon (PDS) dikiþle kolonik anastomoz uygulandý. Ýkinci operasyon postoperatif 7. günde yapýldý. Adezyon skoru, anastomoz kaçaðý, anastomoz patlama basýncý, hidroksiprolin düzeyleri ve histopatolojik incelemeler deðerlendirildi.
BULGULAR: Tüm hayvanlar hayatta kaldý ve deney sýrasýnda anastomoz kaçaðý, baðýrsak týkanýklýðý veya yara enfeksiyonu gözlenmedi. Adezyon skoru Diamond sýnýflamasýna göre deðerlendirildi ve tüm gruplarda aynýydý. Medyan anastomoz patlama basýncý vikril grubunda 125.75 mmHg (10-241), polipropilen grubunda 159.25 mmHg (113-190), PDS grubunda 154.50 mmHg (20-212) bulundu. Hidroksiprolin doku konsantrasyonlarý; vikril grubunda 1699.92±220.8 ng/mg (1509.81-2186.47), polipropilen grubunda 1126.24±607.12 ng/mg (53.22-1815.63) ve PDS grubunda 1547.86±335.2 ng/mg (973.66 -1973.2) bulundu. Histopatoloji ile deðerlendirilen enflamatuvar yanýt açýsýndan gruplar arasýnda fark yoktu. Deðerlendirilen tüm deðiþkenlerde istatistiksel anlamlýlýk görülmedi.
SONUÇ: Bu deneysel çalýþma, intestinal anastomoz ve doku iyileþmesinin dikiþ materyallerine baðlý farklý sonuçlarý olmadýðýný göstermektedir. Emilebilen, yavaþ emilebilen ve emilemeyen dikiþ materyalleri her durumda ve güvenle kullanýlabilir.

Anahtar Kelimeler: Cerrahi anastomoz, hayvan deneyleri; anastomoz iyileþmesi; dikiþ teknikleri; anastomoz kaçaðý.

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