• Birte Kulemann, Sylvia Timme, Gabriel Seifert, Philipp A Holzner, Torben Glatz, Olivia Sick, Sophia Chikhladze, Peter Bronsert, Jens Hoeppner, Martin Werner, Ulrich T Hopt, and Goran Marjanovic.
• Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany. birte.kulemann@uniklinik-freiburg.de
• Surgery. 2013 Sep 1;154(3):596-603.

BackgroundIt 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.Methods36 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.ResultsOverall, 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.ConclusionIntraoperative 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.Copyright © 2013 Mosby, Inc. All rights reserved.

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