Journal of Investigative Surgery, 20:15–21, 2007 Copyright  c Informa Healthcare ISSN: 0894-1939 print / 1521-0553 online DOI: 10.1080/08941930601126108 ORIGINAL RESEARCH The Role of Dura Mater and Free Peritoneal Graft in the Reinforcement of Colon Anastomosis Ramazan Eryilmaz, MD Department of Surgery, Vakif Gureba Training Hospital, Istanbul, Turkey Munir Samuk, MD, and Osman B. Tortum, MD Department of Surgery, Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey Adem Akcakaya, MD, and Mustafa Sahin, MD Department of Surgery, Vakif Gureba Training Hospital, Istanbul, Turkey Suha Goksel, MD Department of Pathology. Cerrahpasa Medical School, University of Istanbul, Istanbul, Turkey ABSTRACT Anastomotic leakage is the most important complication leading to morbidity and mortality in colorectal surgery. To prevent anastomotic leak- age, a number of drugs with different mechanisms of action were tested, and autogenic grafts and various synthetic materials were used for reinforcement of the anastomotic region. In this experimental study aimed at preventing anas- tomotic leakage and dehiscence, we used dehydrated, lyophilized human dura mater and free peritoneal graft for reinforcement of anastomotic region after primary repair in rats, and investigated whether they are superior to primary anastomosis. The rats were sacrificed 3 and 7 days postoperatively. The anasto- motic region was observed macroscopically for adhesions, bursting pressure of bowel was measured for tensile strength of the anastomosis, and histopathologic evaluation was performed for anastomotic healing. Compared to the control group, dura mater and free peritoneal graft groups displayed a lower bowel burst- ing pressure ( p < .05), worse anastomotic healing ( p < .05), a higher number of adhesions, and presence of anastomotic stricture. In conclusion, both human dura mater and free peritoneal graft reinforcement groups had worse anasto- mosis healing. The results could be attributed to avascularity of grafts and to aggravated adhesions between anastomosis and intra-abdominal organs, which created a favorable environment for reproduction and dispersion of bacteria and consequently led to decreased anastomosis healing. KEYWORDS colon anastomosis, dura mater, free peritoneal graft, leakage, reinforcement A nastomotic leakage is the most important complication causing serious morbidity and mortality after colorectal surgery. In the literature, the leakage rates differ highly, ranging between 5% and 51% [1–4]. The reason for wide range comes from the definition of the leakage and the inability to evaluate the minor leakages without any clinical sign. In colorectal surgery, numerous materials and chemicals have been used to reinforce the anastomo- sis, including drugs such as aprotinin [5], PGE-1 [6], doxycyclin [7], growth Received 3 March 2006; accepted 10 August 2006. Address correspondence to Ramazan Eryilmaz, Vatan Cad. Emlak Konutlari E-4 Blok/55, Fatih-Istanbul 34250, Turkey. E-mail: ramazaneryilmaz@hotmail.com 15