The effects of chlorhexidine gluconate and metronidazole impregnated compresses used on bowel anastomosis in peritonitis environment

The risk of leakage from an anastomosis is higher in large intestine in comparison to the other parts of gastrointestinal trackt due to the presence of large amount of pathogen microorganisms and high collagenase enzyme activity in large intestine. In general surgery clinics, in both elective and emergent colon operations primary anastomosis is avoided during operations especially on the left colon, and multi-step procedures are preferred if there is a dirty abdomen. The aim of this experimental study was to evaluate use of the chlorhexidine gluconate and metronidasole impregnated compresses in terms of anastomosis safety in the left colonic anastomosis in presence of peritonitis.This study was conducted in the experimental research center at Fırat University on 21 Wistar-Albino rats by dividing them in 3 groups of equal numbers. After median laparotomy, the whole layer of left colon was cut 2 cm over the pelvic peritoneum. The faeces within the lumen was spread around the injury for fecal contamination. Then, two layers (fasia and skin) of the abdomen were closed with 3/0 silk. After one day period relaparatomy was made under general anesthesia. The abdomen was cleared isotonic sodium chloride with impregnated material before starting colonic anastomosis in first group and then double layer colonic anastomosis was performed. In the second group abdomen was cleared with the metronidasole impregnated compresses then double layer colonic anastomosis was performed. In the third group abdomen was cleared with the chlorhexidine gluconate impregnated compresses then double layer colonic anastomosis was performed. Tissue hydroksiproline levels, anastomosis bursting pressures were measured and histopathologic findings on the anastomosis line were evaluated on the postoperative tenth day by performing relaparatomy. The highest anastomosis bursting pressure was found in Group III (p<0.05). The highest tissue hydroksiproline level was found in Group III (p<0.005 Group I-III, Group II-III). When histopathologic findings were evaluated by comparing three groups, the healing of the intestine tissue score was found istatistically insignificant between group II and III, for both group II and III healing score was istatistically significant higher than group I (p<0.05 Group I ? III and Group I-II). Consequently, it was observed that cleaning the abdomen before the anastomosis using antibacterial soaked material increased resection safety in the presence of peritonitis and anastomosis safety in primary anastomosis.Key Words: Peritonitis, Colon Anastomosis, Chlorehexidin Hydroclorure, Anastomosis Leakage