Maintenance of GI Function after Bowel Surgery and Immediate Enteral Full Nutrition. I. Doubling of Canine Colorectal Anastomotic Bursting Pressure and Intestinal Wound Mature Collagen Content

Abstract

Following either standardized stapled resection of an ileal blind loop terminus (17 beagles) or construction of a colorectal anastomosis (10 beagles), half the subjects immediately were fed an elemental diet (Vivonex HN). Gastrointestinal (GI) motility and absorption were maintained by exclusion of swallowed air. Controls received the same rate of feeding solution containing only the electrolyte components. Four days postoperatively, the fed beagle's colorectal anastomosis had over double the bursting pressure of the control, 303 +/- 46 mm Hg (p less than 0.001). At this time, the mature collagen content of the fed subjects' ileal wound was undiminished from that of normal ileum 2,223 +/- 336 versus 2,250 +/- 577, contrasting with the 45% decrease of this structural component (OHP) in the wounds of the unfed controls, 1,237 +/- 820 microgram/g of tissue (p less than 0.001). Similarly, the wounds of fed but not unfed subjects had a doubling (p less than 0.001) in concentration of collagen precursors and "new" collagen. The "catabolic" and "lag" phases, as noted in unfed experimental animals, appeared to be reflections of the relative starvation that accompanied the intestinal wounding. With maintenance of GI function and immediate full enteral nutrition, "accelerated healing" was noted relative to the previously considered "norm".