Early enteral and glutamine enriched enteral feeding ameliorates healing of colonic anastomosis

BACKGROUND: To investigate the effects of postoperative early enteral, and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis.
METHODS: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at distal left colon was performed on all animals. Groups 1 and 2; Animals received late (after 4th day postoperatively) enteral feeding. Groups 3 and 4; Animals received early (after 6th hours postoperatively) enteral feeding. Glutamine was added in enteral nutrition protocol in groups 2 (late) and 4 (early). The colonic segment including the anastomosis was excised at the end of 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined.
RESULTS: Bursting pressures levels were measured as 111.6 and 95.8 cm/water (p=0.022) in early and late nutrition groups respectively. Comparison of late enteral feeding groups (1 and 2) showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cm/water; p<0.0001). Highest bursting pressure levels (139 and 138.5 cm/water) were measured in both early and late feeding groups with glutamine.
Tissue hydroxyproline level in early enteral feeding group (2440.3 µg) was significantly (p=0.024) higher than late enteral feeding group (1509.6 µg). The differences were not statistically significant between other groups. Comparison of late enteral feeding groups (1 and 2) showed a considerable difference in favor of group with glutamine (1509.6 vs 1981.6 µg) but not statistically significant (p=0.276).
CONCLUSION: Postoperative early enteral feeding significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses disadvantages of late enteral feeding in point of the resistance of anastomosis. Similar positive and useful, but weaker effects of glutamine supplementation are also valuables on collagen synthesis

Erken enteral ve glütaminli enteral beslenme kolon anastomoz iyileþmesini desteklemektedir

AMAÇ: Postoperatif dönemde total enteral beslenmenin erken uygulanmasý ve beslenme protokolüne glütamin eklenmesinin deneysel kolon anastomoz iyileþmesine etkisini araþtýrmak.
GEREÇ-YÖNTEM: 40 Wistar-albino rat eþit sayýda denek içeren 4 gruba ayrýldý. Tüm deneklere distal sol kolon transseksiyonu ve anastomozu uygulandý. Grup 1 ve 2; geç total enteral beslenme (postoperatif 4. günden itibaren) uygulandý. Grup 3 ve 4; erken total enteral beslenme (postoperatif 6. saatten itibaren) uygulandý. Grup 2 (geç) ve 4 (erken)’te enteral beslenme protokolüne glütamin eklendi. Postoperatif 7. gün sonunda anastomoz içeren kolon segmenti çýkarýlarak anastomoz patlama basýncý ve doku hidroksiprolin deðerleri belirlendi.
BULGULAR: Anastomoz patlama basýncý deðerleri erken grupta 111.6, geç grupta 95.8 cm/su (p=0.022) bulundu. Geç enteral beslenme gruplarý (1 ve 2) karþýlaþtýrýldýðýnda glütaminli grup lehine anlamlý fark (95.8’ e 138.5 cm/su; p<0.0001) saptandý. Gerek erken, gerekse geç dönemde glütaminli enteral beslenmenin uygulandýðý gruplarda en yüksek patlama basýncý deðerleri (139 ve 138.5 cm/su) elde edildi.
Doku hidroksiprolin miktarý erken beslenme grubunda (2440.3 µg), geç beslenme grubuna (1509.6 µg)
göre anlamlý yüksek (p=0.024) bulundu. Diðer gruplar arasý farklar istatistik açýsýndan anlamsýzdý. Geç enteral beslenme gruplarý (1 ve 2) karþýlaþtýrýldýðýnda glütaminli grup lehine anlamlý olmamakla (p=0.276) birlikte sayýsal fark (1509.6 ya 1981.6 µg) saptandý.
SONUÇLAR: Postoperatif dönemde total enteral beslenmenin erken uygulanmasý anastomoz direnci ve kollajen sentezini anlamlý olarak desteklemektedir. Anastomoz direnci açýsýndan enteral yolun geç kullanýldýðý durumda beslenme protokolüne glütamin eklenmesi, geç beslenme olumsuzluklarýný azaltmakta ve geri döndürmektedir. Glütaminin benzer olumlu etkisi daha zayýf olmakla birlikte kollajen sentezi üzerinde de görülmektedir.
Anahtar Kelimeler: Kolon anastomozu, enteral beslenme, glütamin, patlama basýncý, hidroksiprolin.