- Email: [email protected]
Effect of diverting colostomy on collagen metabolism in the colonic wall
EDITORIAL COMMENTS
Effect of Diverting Colostomy on Collagen Metabolism in the Colonic Wall Diller B. Groff, MD, Louisville, Kentucky
The importance of the intestinalcontents on growth and regeneration of the small intestine has been documented [1].In a human model, intestinalbypass for obesity has provided good evidence that the small bowel that isbypassed becomes hypoplastic [2].N o w Blomquist et al [3]have used a collagenassay to show a decrease in collagen synthesis and content in the rat colon distalto a colostomy. The method appears to be valid, although the activity might better be measured using tissue culture techniques with the bowel for the 3H-proline analysis rather than using total body injectionof labeled proline.These investigatorssuggest that the next step is to see ifhealing of the colonic anastomoses in the bypassed colon is affected by these changes in collagen. Established techniques exist for performing this wound healing experiment on the colon.In a clinicalsetting,growing children with Hirschsprung's disease and an imperforate anus have colostomies in place Ibr more than a year. It should be possible to obtain biopsy specimens from the functional end of the colostomy and from the defunctionalized segment and submit them for collagen assay to see ifthere is a lossof collagen content, as there is in the rat model. If there is decreased collagen in the human defunctionalized From the Universityof Loulsvflle School of Medicine, Louisville, Kentuck.
colon, then perhaps steps need to be taken to correct this before an anastomosis with this colon is performed. Some surgeons have bulk laxativessuch as Metamucil ® instilledin the distalcolostomy to keep it functioning while the fecalstream isdiverted.The study of Blomquist et al [3] suggests there m a y be some rationale for this. Analyses of pull-through procedures for definitive repair of congenital defects involving long-term colostomies do not indicate unusual problems with healing of the defunctionalized colon segments [4,5]. Colostomy closure has been reported to have a significant incidence of fecal fistula, although most of the complications reported are wound infections [6]. However, Mollitt and associates [7] reported no anastomotic leaks in 109 colostomy closures after correction of Hirschsprung's disease and imperforate anus. Therefore, findings of Blomquist and co-workers may add to our understanding of colon metabolism, but may not be significant in clinical situations. References I. Johrr..~nLR, Copeland EM, Dudrlck SJ, Llchtenberger CtM,Cas~ GA. Structural and hon-nona!alterations In the gaslrolntestinal tract of parenterally fed rats. Gastroenterology 1975;68; 1177-83. 2. Fenyfi G, Backman L, Haoberg D. M o ~ l o g i c a l changes of the small intestine following jejuno-ileal shunt in obese subjects. Acta Chir Scand 1976;142:154-9. 3. Bk~'nqu|stP, Jibom H, ZederfeMt B. Effect of diverting colostomy on coilag~t metabolism In the colonic waU. Studies in the rat. Am J Surg 1985;149:330-3. 4. Swenson O, ~ JO, FIst~r JH, ~ E. The treatment and postoperative complications of congenital megacolon. Ann Surg 1975;182:266-73. 5. Klelnhaus S, Boley SJ, Sheran M, Sieber WK. Hlrschsprung's disease. A survey of me members of the Surgical Section of the American Academy of Pediatrics. J Pediatr Surg 1979; 14:588-97. 6. McMahon RA, C,ohen SJ, Eckstetn HP. Colostomies in infancy and childhood. Arch Dis Child 1963;38:114-7. 7. Mollltl~ MaI~'igonlMA, Balantine TVN, Grosfeld Jl_ Cok)stomy complications in children. Arch Surg 198.0;115:455-8.
Continued
Volume 149, March llaS
419
Effect of Diverting Colostomy on Collagen Metabolism in the Colonic Wall Diller B. Groff, MD, Louisville, Kentucky
The importance of the intestinalcontents on growth and regeneration of the small intestine has been documented [1].In a human model, intestinalbypass for obesity has provided good evidence that the small bowel that isbypassed becomes hypoplastic [2].N o w Blomquist et al [3]have used a collagenassay to show a decrease in collagen synthesis and content in the rat colon distalto a colostomy. The method appears to be valid, although the activity might better be measured using tissue culture techniques with the bowel for the 3H-proline analysis rather than using total body injectionof labeled proline.These investigatorssuggest that the next step is to see ifhealing of the colonic anastomoses in the bypassed colon is affected by these changes in collagen. Established techniques exist for performing this wound healing experiment on the colon.In a clinicalsetting,growing children with Hirschsprung's disease and an imperforate anus have colostomies in place Ibr more than a year. It should be possible to obtain biopsy specimens from the functional end of the colostomy and from the defunctionalized segment and submit them for collagen assay to see ifthere is a lossof collagen content, as there is in the rat model. If there is decreased collagen in the human defunctionalized From the Universityof Loulsvflle School of Medicine, Louisville, Kentuck.
colon, then perhaps steps need to be taken to correct this before an anastomosis with this colon is performed. Some surgeons have bulk laxativessuch as Metamucil ® instilledin the distalcolostomy to keep it functioning while the fecalstream isdiverted.The study of Blomquist et al [3] suggests there m a y be some rationale for this. Analyses of pull-through procedures for definitive repair of congenital defects involving long-term colostomies do not indicate unusual problems with healing of the defunctionalized colon segments [4,5]. Colostomy closure has been reported to have a significant incidence of fecal fistula, although most of the complications reported are wound infections [6]. However, Mollitt and associates [7] reported no anastomotic leaks in 109 colostomy closures after correction of Hirschsprung's disease and imperforate anus. Therefore, findings of Blomquist and co-workers may add to our understanding of colon metabolism, but may not be significant in clinical situations. References I. Johrr..~nLR, Copeland EM, Dudrlck SJ, Llchtenberger CtM,Cas~ GA. Structural and hon-nona!alterations In the gaslrolntestinal tract of parenterally fed rats. Gastroenterology 1975;68; 1177-83. 2. Fenyfi G, Backman L, Haoberg D. M o ~ l o g i c a l changes of the small intestine following jejuno-ileal shunt in obese subjects. Acta Chir Scand 1976;142:154-9. 3. Bk~'nqu|stP, Jibom H, ZederfeMt B. Effect of diverting colostomy on coilag~t metabolism In the colonic waU. Studies in the rat. Am J Surg 1985;149:330-3. 4. Swenson O, ~ JO, FIst~r JH, ~ E. The treatment and postoperative complications of congenital megacolon. Ann Surg 1975;182:266-73. 5. Klelnhaus S, Boley SJ, Sheran M, Sieber WK. Hlrschsprung's disease. A survey of me members of the Surgical Section of the American Academy of Pediatrics. J Pediatr Surg 1979; 14:588-97. 6. McMahon RA, C,ohen SJ, Eckstetn HP. Colostomies in infancy and childhood. Arch Dis Child 1963;38:114-7. 7. Mollltl~ MaI~'igonlMA, Balantine TVN, Grosfeld Jl_ Cok)stomy complications in children. Arch Surg 198.0;115:455-8.
Continued
Volume 149, March llaS
419