Morphological features of bordering zones with anastomosis during surgical correction of congenital intestinal obstruction

Introduction. Despite the numerous studies carried out to improve the technique for abdominal operations using new suture materials, stitching technologies and various types of intestinal sutures, the failure of intestinal anastomoses sutures remains a serious surgical problem in both adult and pediatric practice. The purpose of our study is a comparative analysis of the healing of the interintestinal fistula using various types of sutures in an experiment on animals (newborn rabbits). Materials and methods. The experiment was performed on 15 newborn rabbits with reproduction of a model of intestinal obstruction at the level of the ileum and the imposition of end-to-end small-intestinal anastomoses and de Lorimier-Harrison plication with interrupted and continuous sutures. 3 groups were formed: the imposition of a plication anastomosis using a single-row continuous suture (group I (n = 5)), an end-to-end anastomosis using a single-row continuous suture (group II (n = 5)), group III (n = 5) - end-to-end anastomosis with a single-row interrupted suture. With the help of modern morphological research methods, the degree of the infiltrative-destructive process in the peri-anastomosed areas has been studied. Results. It was found that when using all types of sutures in the areas surrounding the anastomosis (with an implicit advantage of a continuous suture), similar morphological changes were observed, indicating the remodeling of the mucous membrane (RM), low regenerative potential of the small intestine. Deeper degenerative changes in the small intestine SO were observed during the correction of intestinal obstruction using an interrupted suture. Conclusion. The use of a continuous suture (in some cases (3 out of 5) has some advantage over the interrupted suture in the form of a relative preservation of the proliferative compartment zone with the presence of highly specialized cells. Counting Paneth cells, as an indicator of the regenerative capabilities of the small intestine CO, is a promising and objective method for assessing the quality small bowel anastomosis.

intestinal obstruction, peri-anastomosed areas, highly specialized cells, fibroblasts

1. Morozov D.A., Gorodkov S. Yu. Adapted anastomoses of the small intestine in newborns. Pediatric surgery. 2009;(2):23-28. (in Russ.)@@ Морозов Д. А., Городков С. Ю. Адаптированные анастомозы тонкой кишки у новорожденных. Детская хирургия. 2009;(2):23-28.

2. Egorov V.I., Turusov R. A., Schastlivtsev I. A., Baranov A. O.Intestinal suture. Physical and mechanical aspects. Moscow. Vidar, 2004. (in Russ.)@@ Егоров В. И., Турусов Р.А, Счастливцев И. А., Баранов А. О. Кишечный шов. Физико-механические аспекты. Москва: Видар, 2004.

3. Grunichev A.V., Khodasevich L. S., Khoroshilov N. M.Comparative characteristics of the regeneration of gastrointestinal anastomoses during their formation by various intestinal sutures. Proceedings of the II Congress of the Russian Society of Pathologists. Moscow. MDV Publ., 2006; (2):315-316. (in Russ.)@@ Груничев А. В., Ходасевич Л. С., Хорошилов Н. М. Сравнительная характеристика регенерации желудочно-кишечных анастомозов при их формировании различными кишечными швами. Труды II съезда Российского общества патологоанатомов. Москва: МДВ, 2006; (2):315-316.

4. Babaei H., Ahmadipour S. H., Mohamadimoghadam J., Mohsenzadeh A. The study of newborns with congenital gastrointestinal tract obstruction. J Krishna Institute Med Sciences University. 2014;2(13):10-16.

5. Touloukian R. J. Antenatal intestinal adaptation with experimental jejunoilial atresia. Hi. Ped. Serg.1978; 13(6):468-74. doi: 10.1016/s0022-3468(78)80307-8.

6. Leslie A., Steele J. The interrupted serosubmucosal anastomosis - still the gold standard. Colorectal Dis. 2003;5 (4):362-6. doi: 10.1046/j.1463-1318.2003.00460.x.

7. Holland-Cunz S., Chmelnik M., Roll M., Gunther P., Schafer Karl Herbert. The clipped intestinal non-perforating anastomosis of small bowel: a new technique. Pediatr Surgery Int. 2007;23(1): 87-93. doi: 10.1007/s00383-006-1803-8.

8. Varfolomeev AR. Study of reparative processes in intestinal anastomoses. Pediatric surgery. 2002;(3):44-45. (in Russ.)@@ Варфоломеев А. Р. Изучение репаративных процессов при кишечных анастомозах. Детская хирургия. 2002;(3):44-45.

9. Chirdan L. B., Uba A. F., Pam S. D.Intestinal atresia: management problems in a developing country. Pediatric Surgery International. 2004;20(11-12):834-7. doi: 10.1007/s00383-004-1152-4.

10. Lorimier A. A., Harrison M. R.Intestinal plication in the treatment of atresia. J. Ped. Surg. 1983; 18(6):734-7. doi: 10.1016/s0022-3468(83)80014-1.

11. Gorskiy V.A., Agapov M. A., Klimov A. E., Andreev S. S. The problem of the consistency of the intestinal suture. Practical medicine. 2014; 5 (81):33-38. (in Russ.)@@ Горский В. А., Агапов М. А., Климов А. Е., Андреев С. С. Проблема состоятельности кишечного шва. Практическая медицина. 2014;5(81):33-38.

12. Adams S. D., Stanton M. P. Malrotation and intestinal atresias. Early Hum Dev. 2014 Dec;90(12):921-5. doi: 10.1016/j.earlhumdev.

13. Glabella G. The cross-ply arrangement of collagen fibers in the submucosa of the mammalian small intestine. Cell tissue Res.1987; 248(3):491-7. doi: 10.1007/BF00216474.

14. Shurkalin B.K., Gorskiy V. A., Agapov M. A., Titkov B. E., Azimov R. Kh., Sologubov V. V. Rationale for the use of fibrin-collagen substance with introduced antibacterial drugs to increase the reliability of the intestinal suture. Surgeon. 2011;(3):27-36. (in Russ.)@@ Шуркалин Б. К., Горский В. А., Агапов М.А, Титков Б. Е., Азимов Р. Х., Сологубов В. В. Обоснование использования фибрин-коллагеновой субстанции с внесёнными антибактериальными препаратами для повышения надёжности кишечного шва. Хирург. 2011; (3):27-36.

15. Peterson L. W., Artis D.Intestinal epithelial cells: regulators of barrier function and immune homeostasis. Nat Rev Immunol.2014;14(3):141-53. doi: 10.1038/nri3608.

16. Johansson M. E., SjövalI H., Hansson G. C. The gastrointestinal mucus system in health and disease. Nat Rev Gastroenterol Hepatol. 2013;10(6):352-61. doi: 10.1038/nrgastro.2013.35.

17. Bevins C. L., Salzman N. H. Paneth cells, antimicrobial peptides andmaintenance of intestinal homeostasis. Nat Rev Microbiol. 2011;9(5):356-8. doi: 10.1038/nrmicro2546.

18. Potekhin P. P., Pletneva N. B., Shirokova N. Yu., Sokolova I. L., Kuznetsova T. A., Galova E. A. A method for assessing the state of regeneration in the mucous membrane of the small intestine. Patent for invention No 2267999 dated January 20, 2006. (in Russ.)@@ Потехин П.П, Плетнева Н. Б., Широкова Н. Ю., Соколова И. Л., Кузнецова Т. А., Галова Е. А. «Способ оценки состояния регенерации в слизистой оболочке тонкой кишки». Патент на изобретение No 2267999 от 20 января 2006 г.

19. Lueschow S. R., Stumphy J., Gong H., Kern S. L., Elgin T. G., Underwood М. А. et al. Loss of murine Paneth cell function alters the immature intestinal microbiome and mimics changes seen in neonatal necrotizing enterocolitis. PLoS One. 2018 Oct 1;13(10): e0204967. doi: 10.1371/journal.pone.0204967.

20. Clevers H. C., Bevins C. L. Paneth cells: Maestros of the small intestinal crypts. Annu Rev Physiol. 2013;75:289-311. doi: 10.1146/annurev-physiol-030212-183744

21. Potekhin P.P., Pereslegina I. A., Shirokova N. Yu., Sokolova I. L., Saralov S. N., Zhukova E. A., Artyomova A. V. Method for predicting the course of peptic ulcer disease in children. Patent for invention No. 2162600, dated 27.01.2001.(in Russ.)@@ Потехин П. П., Переслегина И. А., Широкова Н. Ю., Соколова И. Л., Саралов С. Н., Жукова Е. А., Артёмова А. В. «Способ прогнозирования течения язвенной болезни у детей». Патент на изобретение № 2162600, от.27.01.2001 г.