Effects of extensive mobilization and tension anastomosis in anorectal reconstruction (experimental study)

Abstract

Anorectoplasty and pull-through procedure can be performed with extended mobilization or tension anastomosis, which can compromise the vasculature of the rectum. We aimed to analyze the histopathological ndings, hypoxia biomarker values and to correlate the incidence of anal stenosis and defecation disorders of both conditions in experimental models. MethodsWe created anorectal reconstruction models during anorectal mobilization with extended mobilization with impaired vascularization (group I) and tension anastomosis (group II) in rats. Hypoxia biomarker values was assessed in both groups and in sham operated animals (group III). The histopathological changes on the 3 rd postoperative day, anal stenosis and defecation disorders on the 35 th day are compared with each other and with a control group (group IV). ResultsHypoxia biomarker levels con rmed postoperative ischemia in I -III groups compared to the control.Groups I, II are accompanied by pronounced histopathological changes in the anorectum on the 3rd postoperative day and accompanied by severe brosis on the 35 th day. In comparison to group III, both groups showed defecation disorders and anal stenoses. ConclusionExtensive mobilization with vascular impairment and tension anastomosis resulted in similar ischemia with histopathologic changes, which in the long term resulted in brotic changes associated with defecation disorders.

Anatomical Anal Stenosis after PPH: Insights from a Retrospective Study and Rat Model

“…An animal study has shown that there was significant anal stenosis and active angiogenesis in the anorectoplasty and pull-through procedure performed with tension anastomosis. Tension anastomosis resulted in tissue ischemia and was accompanied by the increase in VEGF-C and HIF-1α expression [ 58 ]. That might explain the reason for tension-induced angiogenesis.…”