The effects of the pharmacological manipulation of postoperative intestinal motility on colonic anastomoses - An experimental study in a rat model

Introduction: The aim of the study was to determine the effects of pharmacological manipulation of postoperative intestinal motility on the resistance of colonic anastomoses. Materials and methods: Seventy-one Spraque-Dawley rats were divided into three groups: Group 1 (n = 20; colonic anastomosis + 1 cc of saline solution subcutaneously, daily); Group 2 (n = 29; colonic anastomosis + 1.2 mg/100 g body weight metoclopramide in 1 cc subcutaneously, daily); and Group 3 (n = 22; colonic anastomosis + 2 mg/100 g body weight hyoscine N-butylbromide in 1 cc subcutaneously, daily). Surviving rats (20 in each group) were sacrificed 4 days after surgery and adhesions were evaluated. Each segment containing an anastomosis was removed and the bursting pressure was determined. Results: The cause of death during the early postoperative period was dehiscence in 8 cases (7 in Group 2 and 1 in Group 3). General adhesion scores in Group 2 were higher than in Group 3 (P = 0.003). The score for adhesions to the anastomosis in Group 1 was higher than in Group 2, but no statistically significant difference was found. Bursting pressure was significantly lower in Group 2 than in other groups (P = 0.001). In all cases leakage of dye was observed at the anastomosis. Conclusion: The use of metoclopramide (a gastrointestinal prokinetic agent) during the early postoperative period was associated with an increase in dehiscence in colonic anastomosis and, when animals survived, there was a significant decrease in anastomotic resistance. Hyoscine (an inhibitor of gastrointestinal motility) did not improve the healing of anastomoses.