To the Editor.—In the November 1991 issue of the Archives, Jonsson and Högström1 demonstrate the loss of integrity by as much as 80% in holding power in early postoperative gastrointestinal anastomoses. This is initiated following neutrophilic activation.1,2 Besides collagenolytic proteinases, hexane oxidaseis generated. Angioneogenesis brings increased oxygen to relatively anoxic postoperative tissue.
The combination of hexane oxidase, oxygen, and water produces hydrogen peroxide, which has a toxic effect on tissues. Could this react on adjacent tissues to produce the adhesions that frequently accompany gastrointestinal operations? This could be a defense mechanism to protect against the concurrent weakening of the anastomotic sutures. The part of the series that described the use of allopurinol and superoxide dismutase to block the effect of hexane oxidase3 and the production of neutropenia to prevent the formation of hexane oxidase might present an additional finding, that of fewer adhesions.