Letter to the editor

Excerpt

We read with great attention the original article by Posma et al. entitled “ A prolonged interval between intestinal ischemia and anastomotic construction does not impair wound strength in the rat” [1]. As it has been known, wide application of laparoscopic colorectal procedures, which has been performed for the treatment of all kind of surgical pathologies, demonstrated the advantages of minimally invasive surgery such as less postoperative pain, early ambulation, shorter hospitalization, and better cosmesis. These advantages has resulted in the application of laparoscopy for various types of procedures, as it has been shown that ischemia and reperfusion of the intestinal segment or colon wall can lead to impaired anastomotic strength; this ischemia is a feared problem in surgery. As it has been performed in almost each field of surgery, laparoscopic colonic procedures have been performed for these surgical pathologies. For these procedures, carbon dioxide pneumoperitoneum is realized via intraperitoneal insufflation. Increased intraabdominal pressure is an important cause of gastrointestinal ischemia. Impaired perfusion of splanchnic organs secondary to increased intraabdominal pressure during pneumoperitoneum and their reperfusion after pneumoperitoneum represent ischemia and reperfusion, respectively. Ischemia–reperfusion injury is responsible for most of the damage complicating reversible arterial insufficiency of the intestine. Ischemia–reperfusion injury impairs anastomotic healing in the bowel and is the most likely mechanism of the detrimental effect of the high intraabdominal pressures on colonic anastomoses reported originally by our group [2, 3]. We think that, if the authors could have added a paragraph that is associated with “laparoscopic surgery and its detrimental effects on small and large bowel anastomes” to their article, the present study will acquire more valuable and scientific condition. …