Considerações finais

É relevante destacar que, neste trabalho, não foram estudados todos os aspectos referentes à cicatrização das feridas no estômago. A ocorrência de aderências e seu envolvimento nas suturas foram entre os fatores analisados, aqueles que apresentaram importante diferença estatística entre os grupos.

Nos grupos com aumento de pressão intra-abdominal, as aderências estiveram mais presentes e mais intensas, sugerindo a necessidade de fluxo vascular suplementar proporcionado pelo omento aderido à sutura.

Nas variáveis microscópicas analisadas, o edema e a congestão vascular são fenômenos que provavelmente influenciam na maior lentidão e no retardo do reparo nas suturas estudadas. Isso se tornou mais evidente, naqueles grupos que permaneceram por maior tempo sofrendo ação mecânica externa, provocada pela presença de alta pressão de CO2 intra-abdominal.

O aumento de pressão intra-abdominal entre 12 e 14 mm de Hg, somado a longo tempo de exposição ao pneumoperitônio, estiveram associados ao aumento no tempo da cicatrização das feridas. Esses achados reforçam a importância do emprego da monitorização contínua e cuidadosa do pneumoperitônio, pois são evidentes fatores que promovem retardo na cicatrização dos tecidos.

Esses fatores associados apresentam relevância para a pesquisa com vistas à aplicabilidade clinica, o que nos permite acreditar que este trabalho abre novas perspectivas de estudo com intuito de aprimoramento na área cirúrgica.

Talvez, interrupções periódicas do pneumoperitônio, durante o ato operatório, possam diminuir o processo de isquemia e edema na parede do órgão, podendo assim, evitar retardo da cicatrização.

Esses achados poderiam motivar outros projetos de pesquisa no futuro, empregando-se variações técnicas como interrupções periódicas do pneumoperitônio ou mudança do gás empregado.

Estudando-se aspectos macro e microscópicos do processo de cicatrização de suturas no estômago de dois grupos de animais que tiveram diferentes tempos de aumento de pressão intra-abdominal provocada por pneumoperitônio, comparando-os com outro grupo que não foi submetido a esse aumento de pressão, concluiu-se que no 7º dia de pós-operatório:

1. o processo de cicatrização das suturas se desenvolveu em estágios evolutivos diferentes em cada grupo de animais;

2. as suturas submetidas ao aumento de pressão intra-abdominal tiveram retardo no processo normal de cicatrização;

3. as suturas submetidas a tempo maior de pneumoperitônio (120 minutos) apresentaram evidências que demonstraram retardo do processo de cicatrização quando comparadas àquelas que sofreram essa ação por 60 minutos. Esse fato ficou ainda mais patente quando se comparou esse processo de cicatrização com o do grupo que não sofreu ação do pneumoperitônio.

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ABSTRACT

Purpose: To assess the initial healing after placing a gastric suture with a linear cutting stapler and creating pneumoperitoneum (12-14 mmHg) for 60 minutes or 120 minutes, and compare it with the healing after placing a suture under normal pressure. Methods: A total of 30 dogs were divided into three groups of 10 animals each: Group I (control group – mechanical suture), Group II (mechanical suture and increased intra-abdominal pressure in the first 60 minutes) and Group III (mechanical suture and increased intra- abdominal pressure in the first 120 minutes). All dogs were maintained under general anesthesia for two hours after suturing. Seven days after surgery, the area around the mechanical suture was macroscopically and microscopically examined. Results: The macroscopic examination of the samples (n = 30) did not show dehiscence, fistula or abscess. Adhesions between the omentum and the suture were observed in all animals of groups II and III (n = 20), which were significantly different from group I (p = 0.008*). The histopathological analysis showed normal healing up to day 7 in the control animals (n = 10). When these results were compared with those of groups II and III (n = 20), non-parametric tests revealed that there was a significant difference with regard to certain parameters of the early stages of healing, such as fibroblast migration (p = 0.011*), edema (p < 0.001*) and congestion (p = 0.011*). These alterations affected reepithelization (p < 0.001*), and consequently the late stages of healing. Conclusions: Each group showed different healing stages, and the healing process was delayed in the groups submitted to increased pressure. This was more pronounced in the group submitted to increased pressure for longer.

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