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Rimereit JE, Lindgren CGW, Nerup N, Madsen GI, Le DQS, Möller S, Qvist N, Ellebaek MB. Incorporating a poly-ε-caprolactone scaffold in a stapled small intestinal anastomosis with induced ischemia significantly increased anastomotic tensile strength. An experimental study in pigs. Scand J Gastroenterol 2025; 60:54-61. [PMID: 39636738 DOI: 10.1080/00365521.2024.2433541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 11/10/2024] [Accepted: 11/17/2024] [Indexed: 12/07/2024]
Abstract
OBJECTIVE Anastomotic leakage is a severe complication with multifactorial aetiology, including impaired tissue oxygenation, infection, inflammation, and anastomotic tension. Reinforcement with poly-ε-caprolactone (PCL) scaffold incorporated in a stapled intestinal anastomosis has demonstrated a significant increase in the anastomotic tensile strength. This study aimed to investigate whether incorporation of the scaffold would influence tensile strength with induced ischemia compared to normal blood perfusion. METHODS Eighteen pigs were randomly allocated into an intervention group with a induced relative reduction in blood perfusion to 30% at the anastomotic area and a control group with normal perfusion controlled by quantitative fluorescence angiography. Each pig recieved two stapled small intestinal anastomoses, one with a PCL scaffold incorporated and one without. On postoperative day five, the anastomoses were subjected to a maximal tensile strength test (MATS) and a histopathological analysis. Tensile strength was measured at three events: when a serosal tear became visible (MATS-1), at transmural rupture (MATS-2), and at maximum load before the load-strain curve dropped (MATS-3). RESULTS In the intervention group, MATS-1 was significantly higher in scaffold-reinforced anastomoses compared to controls (7.9 ± 4.2N and 4.4 ± 2.5N, p < 0.02). The same tendency was found for MATS-2 and MATS-3, with statistically significant differences after adjusting for adhesion grade (p < 0.05). Histological analysis revealed no significant differences in wound healing between groups. CONCLUSION Incorporating a PCL scaffold in a stapled small intestinal anastomosis with induced ischemia improved anastomotic tensile strength.
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Affiliation(s)
- Jon Erlend Rimereit
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Carl Gunnar William Lindgren
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Nikolaj Nerup
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gunvor Iben Madsen
- University of Southern Denmark, Odense, Denmark
- Research Unit for Pathology, Odense University Hospital, Odense, Denmark
| | | | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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Zheng MY, Dybro PT, Möller S, Madsen GI, Kjær MD, Qvist N, Ellebæk MB. Short cycles of remote ischemic preconditioning had no effect on tensile strength in small intestinal anastomoses: an experimental animal study. J Gastrointest Surg 2024; 28:1777-1782. [PMID: 39128558 DOI: 10.1016/j.gassur.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/19/2024] [Accepted: 08/06/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE This study aimed to investigate the effect of remote ischemic preconditioning (RIPC) on the healing of small intestinal anastomoses, evaluated by tensile strength and histologic wound healing on postoperative day 5. METHODS A total of 22 female pigs were randomized 1:1 into either an intervention or control group. The intervention group received 5 cycles of 3-minute ischemia followed by 3-minute reperfusion on the right forelimb. Two end-to-end anastomoses, a distal and a proximal, were created in the small intestine 30 and 60 min after RIPC, respectively. On postoperative day 5, the anastomoses were harvested and underwent a maximal anastomotic tensile strength (MATS) test (MATS 1-3) followed by histologic analyses. RESULTS MATS 1, when a tear became visible in the serosa, was significantly increased in the proximal anastomoses of the RIPC group compared with the control group (4.91 N vs 3.83 N; P = .005). No other significant differences were found when comparing these 2 groups. CONCLUSION Our study showed no convincing results of RIPC on intestinal anastomotic healing to recommend its use in a general clinical setting. Further animal studies on RIPC's effect after relative or absolute intestinal ischemia may be recommended.
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Affiliation(s)
- Mei-Yun Zheng
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
| | - Paula Thrane Dybro
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Gunvor Iben Madsen
- Research Unit for Pathology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mie Dilling Kjær
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark; Department of Surgery, Odense University Hospital, Odense, Denmark
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Lambrou I, Mantzoros I, Ioannidis O, Tatsis D, Anestiadou E, Bisbinas V, Pramateftakis MG, Kotidis E, Driagka B, Kerasidou O, Symeonidis S, Bitsianis S, Sifaki F, Angelopoulos K, Demetriades H, Angelopoulos S. Effect of growth hormone on colonic anastomosis after intraperitoneal administration of 5-fluorouracil, bleomycin and cisplatin: An experimental study. World J Gastrointest Surg 2024; 16:2679-2688. [PMID: 39220091 PMCID: PMC11362934 DOI: 10.4240/wjgs.v16.i8.2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/20/2024] [Accepted: 06/17/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Growth hormone (GH) plays a crucial role in wound healing and tissue repair in postoperative patients. In particular, colonic anastomosis healing following colorectal surgery is impaired by numerous chemotherapy agents. AIM To investigate whether GH can improve the healing of a colonic anastomosis following the adverse effects of intraperitoneal administration of 5-fluorouracil (5-FU), bleomycin and cisplatin. METHODS Eighty Wistar rats underwent laparotomy and a 1 cm-resection of the transverse colon, followed by an end-to-end anastomosis under general anesthesia. The rats were blindly allocated into four equal groups and administered a different daily intraperitoneal therapeutic regimen for 6 days. The control group (A) received normal saline. Group B received chemotherapy with 5-FU (20 mg/kg), bleomycin (4 mg/kg) and cisplatin (0.7 mg/kg). Group C received GH (2 mg/kg), and group D received the aforementioned combination chemotherapy and GH, as described. The rats were sacrificed on the 7th postoperative day and the anastomoses were macroscopically and microscopically examined. Body weight, bursting pressure, hydroxyproline levels and inflammation markers were measured. RESULTS All rats survived until the day of sacrifice, with no infections or other complications. A decrease in the body weight of group D rats was observed, not statistically significant compared to group A (P = 1), but significantly different to groups C (P = 0.001) and B (P < 0.01). Anastomotic dehiscence rate was not statistically different between the groups. Bursting pressure was not significantly different between groups A and D (P = 1.0), whereas group B had a significantly lower bursting pressure compared to group D (P < 0.001). All groups had significantly more adhesions than group A. Hydroxyproline, as a measurement of collagen deposition, was significantly higher in group D compared to group B (P < 0.05), and higher, but not statistically significant, compared to group A. Significant changes in group D were recorded, compared to group A regarding inflammation (3.450 vs 2.900, P = 0.016) and fibroblast activity (2.75 vs 3.25, P = 0.021). Neoangiogenesis and collagen deposition were not significantly different between groups A and D. Collagen deposition was significantly increased in group D compared to group B (P < 0.001). CONCLUSION Intraperitoneal administration of chemotherapy has an adverse effect on the healing process of colonic anastomosis. However, GH can inhibit the deleterious effect of administered chemotherapy agents and induce colonic healing in rats.
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Affiliation(s)
- Ioannis Lambrou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Ioannis Mantzoros
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Dimitrios Tatsis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Vasiliki Bisbinas
- Department of ENT, Royal Cornwall Hospitals NHS Trust, Cornwall TR1 3LJ, United Kingdom
| | | | - Efstathios Kotidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Barbara Driagka
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Ourania Kerasidou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Savvas Symeonidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Freideriki Sifaki
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Konstantinos Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Haralabos Demetriades
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stamatios Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Ntampakis G, Pramateftakis MG, Anestiadou E, Bitsianis S, Ioannidis O, Bekiari C, Koliakos G, Karakota M, Tsakona A, Cheva A, Angelopoulos S. Experimental models of high-risk bowel anastomosis in rats: A systematic review. World J Exp Med 2024; 14:94135. [PMID: 38948424 PMCID: PMC11212746 DOI: 10.5493/wjem.v14.i2.94135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/23/2024] [Accepted: 05/10/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Anastomotic leaks remain one of the most dreaded complications in gastrointestinal surgery causing significant morbidity, that negatively affect the patients' quality of life. Experimental studies play an important role in understanding the pathophysiological background of anastomotic healing and there are still many fields that require further investigation. Knowledge drawn from these studies can lead to interventions or techniques that can reduce the risk of anastomotic leak in patients with high-risk features. Despite the advances in experimental protocols and techniques, designing a high-quality study is still challenging for the investigators as there is a plethora of different models used. AIM To review current state of the art for experimental protocols in high-risk anastomosis in rats. METHODS This systematic review was performed according to The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To identify eligible studies, a comprehensive literature search was performed in the electronic databases PubMed (MEDLINE) and Scopus, covering the period from conception until 18 October 2023. RESULTS From our search strategy 102 studies were included and were categorized based on the mechanism used to create a high-risk anastomosis. Methods of assessing anastomotic healing were extracted and were individually appraised. CONCLUSION Anastomotic healing studies have evolved over the last decades, but the findings are yet to be translated into human studies. There is a need for high-quality, well-designed studies that will help to the better understanding of the pathophysiology of anastomotic healing and the effects of various interventions.
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Affiliation(s)
- Georgios Ntampakis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | | | - Elissavet Anestiadou
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Stefanos Bitsianis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Orestis Ioannidis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
| | - Chryssa Bekiari
- Laboratory of Anatomy and Histology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
- Experimental and Research Center, Papageorgiou General Hospital of Thessaloniki, Thessaloniki 56403, Greece
| | - George Koliakos
- Laboratory of Biochemistry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Maria Karakota
- Laboratory of Biochemistry, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Anastasia Tsakona
- Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Angeliki Cheva
- Department of Pathology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Stamatios Angelopoulos
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki 57010, Greece
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Petersen LLK, Dursun MD, Madsen G, Le DQS, Möller S, Qvist N, Ellebæk MB. Poly-ϵ-caprolactone scaffold as staple-line reinforcement of rectal anastomosis: an experimental piglet study. BMC Gastroenterol 2024; 24:112. [PMID: 38491416 PMCID: PMC10943786 DOI: 10.1186/s12876-024-03202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/11/2024] [Indexed: 03/18/2024] Open
Abstract
PURPOSE Rectal anastomoses have a persisting high incidence of anastomotic leakage. This study aimed to assess whether the use of a poly-ϵ-caprolactone (PCL) scaffold as reinforcement of a circular stapled rectal anastomosis could increase tensile strength and improve healing compared to a control in a piglet model. METHOD Twenty weaned female piglets received a stapled rectal anastomosis and were randomised to either reinforcement with PCL scaffold (intervention) or no reinforcement (control). On postoperative day five the anastomosis was subjected to a tensile strength test followed by a histological examination to evaluate the wound healing according to the Verhofstad scoring. RESULTS The tensile strength test showed no significant difference between the two groups, but histological evaluation revealed significant impaired wound healing in the intervention group. CONCLUSION The incorporation of a PCL scaffold into a circular stapled rectal anastomosis did not increase anastomotic tensile strength in piglets and indicated an impaired histologically assessed wound healing.
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Affiliation(s)
- Laura Lovisa Køtlum Petersen
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Martin Dennis Dursun
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark.
- University of Southern Denmark, Odense, Denmark.
| | - Gunvor Madsen
- Research Unit of Pathology, Odense University Hospital, Odense, Denmark
| | | | - Sören Möller
- Open Patient data Explorative Network, Department of Clinical Research, Odense University Hospital and Research unit OPEN, University of Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit of Surgery, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
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Celen S, Ozlulerden Y, Baser A, Alkış O, Kucuker K, Duran MB. Can Neoadjuvant Chemotherapy Cause Postoperative Hydronephrosis After Radical Cystectomy? Cureus 2024; 16:e57306. [PMID: 38690486 PMCID: PMC11059171 DOI: 10.7759/cureus.57306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE This study's objective is to assess the effect of preoperative factors on postoperative hydroureteronephrosis (HUN) after radical cystectomy (RC) in patients with bladder cancer (BC). METHODOLOGY Patients who underwent RC for BC between January 2019 and November 2022 and had unilateral or bilateral postoperative HUN were retrospectively analyzed. Patients without preoperative HUN but with postoperative HUN constituted the patient group, while patients without both preoperative and postoperative HUN constituted the control group, and they were compared with each other. RESULTS Neoadjuvant chemotherapy (NAC) and postoperative metastasis were positively correlated with postoperative HUN (r = 0.238, P = 0.007, and r = 0.203, P = 0.021, respectively). Multivariate logistic regression analysis showed that the postoperative HUN was significantly associated with NAC (P = 0.048; Exp(B) = 6.896, 95% confidence interval [CI] 1.02-46.9) but not associated with the presence of metastasis (P = 0.054). Moreover, NAC increased the possibility of undergoing revision surgery (P = 0.002; Exp(B) = 26.9, 95% CI 3.2-225). CONCLUSIONS NAC is an independent factor for impaired anastomotic healing, increased postoperative HUN, and the need for revision surgery in patients with BC.
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Affiliation(s)
- Sinan Celen
- Urology, Pamukkale University School of Medicine, Denizli, TUR
| | | | - Aykut Baser
- Urology, Bandirma Onyedi Eylul University School of Medicine, Balikesir, TUR
| | - Okan Alkış
- Urology, Kutahya Health Science University, Kütahya, TUR
| | - Kursat Kucuker
- Urology, Pamukkale University School of Medicine, Denizli, TUR
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Geropoulos G, Psarras K, Papaioannou M, Geropoulos V, Niti A, Nikolaidou C, Koimtzis G, Symeonidis N, Pavlidis ET, Koliakos G, Pavlidis TE, Galanis I. The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats. J Pers Med 2024; 14:121. [PMID: 38276243 PMCID: PMC10817310 DOI: 10.3390/jpm14010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/22/2023] [Accepted: 12/25/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Multiple factors have been linked with increased risk of anastomotic leak in bowel surgery, including infections, inflammatory bowel disease, patient comorbidities and poor surgical technique. The aim of this study was to investigate the positive effect, if any, of adipose derived mesenchymal stem cells (MSCs) mixed with platelet-rich plasma (PRP) in the healing of bowel anastomoses, in an inflammatory environment after establishment of experimental colitis. Materials and Methods: Thirty-five male Wistar rats were divided into five groups of seven animals: normal controls, colitis controls, PRP, MSCs, and PRP+MSCs. All groups underwent laparotomy, one-cm segmental colectomy and anastomosis in situ. In the colitis group, colectomy was performed at the affected area. Colitis was previously established by transrectal administration of 2,4,6-trinitrobenzene sulfonic acid (TNBS) except for the normal controls. Post-mortem histopathological, tissue hydroxyproline and anastomotic bursting pressure (ABP) assessments were performed. The Mann-Whitney U test was used to assess statistical significance differences between groups. Results: No perioperative mortality was noted. Tissue hydroxyproline and ABP were significantly increased in the group of PRP+MSCs compared to colitis controls (p = 0.0151 and p = 0.0104, respectively). Inflammatory cell infiltration was lower and fibroblast activity higher in PRP+MSCs group, but not statistically significant (p > 0.05). Neoangiogenesis (p = 0.0073) and anastomotic area epithelialization (p = 0.0182) were significantly higher in PRP + MSCs group compared to colitis controls. Discussion: The synergistic effect of the PRP and MSCs is apparently responsible for the improved healing markers in bowel anastomoses even on inflammatory bowel. This gives hope for primary anastomoses and stoma saving in many emergency and/or elective circumstances, especially in immunocompromised or malnourished patients, even in cases with inflammation or peritonitis. Clinical studies should follow in order to support the clinical application of PRP+MSCs in gastrointestinal anastomoses.
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Affiliation(s)
- Georgios Geropoulos
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Kyriakos Psarras
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Vasileios Geropoulos
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Argyri Niti
- Biohellenika Biotechnology Company, 55535 Thessaloniki, Greece; (A.N.)
| | - Christina Nikolaidou
- Department of Histopathology, Hippokration Hospital, 54642 Thessaloniki, Greece;
| | - Georgios Koimtzis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Nikolaos Symeonidis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Efstathios T. Pavlidis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Georgios Koliakos
- Biohellenika Biotechnology Company, 55535 Thessaloniki, Greece; (A.N.)
| | - Theodoros E. Pavlidis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
| | - Ioannis Galanis
- 2nd Propaedeutical Department of Surgery, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece (G.K.); (N.S.); (E.T.P.); (T.E.P.); (I.G.)
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Albahrawy M, Abass M, Mosbah E, Karrouf G, Awadin W, Zaghloul A. Reinforcement of colon anastomosis healing with leukocyte platelet-rich fibrin in rabbit model. Life Sci 2023; 333:122146. [PMID: 37802197 DOI: 10.1016/j.lfs.2023.122146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/25/2023] [Accepted: 10/03/2023] [Indexed: 10/08/2023]
Abstract
AIM This study investigated the regenerative efficacy of leukocyte platelet-rich fibrin (L-PRF) on colon anastomotic healing in rabbits. MAIN METHODS Thirty-six healthy male white New Zealand rabbits were subjected to complete transactions of the ascending colon. The rabbits were equally divided into two groups: the control group, where the transected colon ends were anastomosed by a simple interrupted suture pattern, and the L-PRF-treated group, in which L-PRF was wrapped entirely around the anastomotic line. The postoperative acute pain scale was assessed using the Bristol Rabbit Pain Scale before surgery and at each four-hour interval post-operatively. After euthanizing the rabbits, the adhesion degree score, anastomotic bursting pressure, and stenosis degree of the anastomotic colon were assessed, and histopathological examination at the 7th, 14th, and 28th days postoperatively. KEY FINDINGS Rabbits in both groups showed a significant increase in pain scores compared to baseline. Postoperatively, the L-PRF group exhibited significantly lower pain scores, adhesion scores, and stenosis degrees than the control group. However, the anastomotic bursting pressure was significantly higher in the L-PRF group. Re-epithelialization, polymorphonuclear neutrophil infiltration, granulation tissue formation, and collagen deposition scores were improved considerably in the L-PRF group compared to the control group. Immunostaining of growth factor expression was significantly lower in the control than in the L-PRF group. SIGNIFICANCE The L-PRF can augment collagen deposition, re-epithelialize the mucosa, promote angiogenesis, reduce adhesions, and diminish the stenosis degree scores. Therefore, it can be considered a promising aid in healing bowel anastomoses.
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Affiliation(s)
- Mohammed Albahrawy
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Marwa Abass
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Esam Mosbah
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Gamal Karrouf
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Walaa Awadin
- Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Adel Zaghloul
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
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Caulk AW, Chatterjee M, Barr SJ, Contini EM. Mechanobiological considerations in colorectal stapling: Implications for technology development. Surg Open Sci 2023; 13:54-65. [PMID: 37159635 PMCID: PMC10163679 DOI: 10.1016/j.sopen.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/07/2023] [Accepted: 04/08/2023] [Indexed: 05/11/2023] Open
Abstract
Technological advancements in minimally invasive surgery have led to significant improvements in patient outcomes. One such technology is surgical stapling, which has evolved into a key component of many operating rooms by facilitating ease and efficacy in resection and repair of diseased or otherwise compromised tissue. Despite such advancements, adverse post-operative outcomes such as anastomotic leak remain a persistent problem in surgical stapling and its correlates (i.e., hand-sewing), most notably in low colorectal or coloanal procedures. Many factors may drive anastomotic leaks, including tissue perfusion, microbiome composition, and patient factors such as pre-existing disease. Surgical intervention induces complex acute and chronic changes to the mechanical environment of the tissue; however, roles of mechanical forces in post-operative healing remain poorly characterized. It is well known that cells sense and respond to their local mechanical environment and that dysfunction of this "mechanosensing" phenomenon contributes to a myriad of diseases. Mechanosensing has been investigated in wound healing contexts such as dermal incisional and excisional wounds and development of pressure ulcers; however, reports investigating roles of mechanical forces in adverse post-operative gastrointestinal wound healing are lacking. To understand this relationship well, it is critical to understand: 1) the intraoperative material responses of tissue to surgical intervention, and 2) the post-operative mechanobiological response of the tissue to surgically imposed forces. In this review, we summarize the state of the field in each of these contexts while highlighting areas of opportunity for discovery and innovation which can positively impact patient outcomes in minimally invasive surgery.
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10
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Ersan M, Kaya B, Özdemir A, Işık Z, Tunç AS, Mamuk S, Durdurur A, Gültan SM, Ergün H. The effect of taurine on flap perfusion and viability in random pattern flaps in rats. Injury 2023:S0020-1383(23)00428-X. [PMID: 37208253 DOI: 10.1016/j.injury.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND In present study, the effect of taurine on flap perfusion and viability was examined using the modified random pattern dorsal flap model (DFM). MATERIALS AND METHODS Eighteen rats were included and divided equally (n=9) to taurine treatment and control groups in this study. Taurine treatments were given orally at a dose of 100 mg/kg/day. Taurine group received taurine, starting 3 days before the operation till the postoperative 3rd day. Angiographic images were recorded when the flaps were sutured back and on postoperative 5th and 7th days. Necrosis calculations were made with all the images obtained by the digital camera and the indocyanine green angiography. Fluorescence intensity, fluorescence filling rate and flow rate of DFM were calculated by the SPY device and the SPY-Q software. All flaps were analyzed histopathologically, also. RESULTS Perioperative taurine treatment significantly reduced necrosis rates and increased the fluorescence density, the fluorescence filling rate and the flap filling rates in the DFM (p<0.05). Reduced amounts of necrosis, ulcer and polymorphonuclear leukocyte supported the beneficial effect of taurine histopathologically (p<0.05). CONCLUSIONS Taurine may be used as an effective medical agent for prophylactic treatment options in flap surgery.
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Affiliation(s)
- Mert Ersan
- Ankara University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department, Ankara
| | - Burak Kaya
- Ankara University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department, Ankara
| | - Arda Özdemir
- Ankara University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department, Ankara
| | - Ziya Işık
- Ankara University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department, Ankara
| | - Arda Selin Tunç
- Ankara University Faculty of Veterinary, Department of Veterinary Pathology, Ankara
| | - Soner Mamuk
- Ankara University Faculty of Medicine, Department of Medical Pharmacology, Ankara
| | - Aygül Durdurur
- Ankara University Faculty of Medicine, Department of Medical Pharmacology, Ankara.
| | - Serdar Mehmet Gültan
- Ankara University Faculty of Medicine, Plastic Reconstructive and Aesthetic Surgery Department, Ankara
| | - Hakan Ergün
- Ankara University Faculty of Medicine, Department of Medical Pharmacology, Ankara
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11
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Sag S, Elemen L, Masrabaci K, Recber SF, Sonmez Y, Aydin S, Yanar K, Seker E, Yazir Y. Potential therapeutic effects of ethyl pyruvate in an experimental rat appendicitis model. J Pediatr Surg 2022; 57:457-462. [PMID: 34865830 DOI: 10.1016/j.jpedsurg.2021.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pathophysiology of appendicitis is associated with the underlying inflammatory processes. Ethyl pyruvate (EP) has potent antioxidant and anti inflammatory properties. In this study, we aimed to investigate the effects of EP on the treatment of appendicitis and to examine whether adding EP to the antibiotic treatment could increases the effectiveness of the treatment in a rat appendicitis model. METHOD Thirty two Wistar rats, which had previously created appendicitis, were randomly divided into 4 groups: Group 1 (0.1 ml saline solution), Group 2 (15 mg/kg ceftriaxone), Group 3 (50 mg/kg EP), Group 4 (EP 50 mg/kg + ceftriaxone 15 mg/kg). In all groups, saline solution, ceftriaxone and EP were administered intraperitoneally and the same procedure was repeated twice a day for the following five days. On day 6, the rats underwent relaparotomy and then intraabdominal findings were recorded. Histopathological examination and interleukin 6 (IL 6) level were performed on appendiceal specimens. RESULTS Intra abdominal adhesion score was significantly lower in Group 4 than in Group 1. Total inflammation score was significantly lower in Group 2 than in Group 1 and was significantly lower in Group 4 than in Group 3 and 1. IL 6 level was significantly lower in Group 4 than in Group 3 and 1. CONCLUSION We found that adding EP to the antibiotic therapy increased the efficacy of the treatment in the rat appendicitis model. Further studies are required to apply our findings to the clinical setting.
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Affiliation(s)
- Sefa Sag
- Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Surgery, University of Health Sciences, Istanbul, Turkey.
| | - Levent Elemen
- Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Surgery, University of Health Sciences, Istanbul, Turkey
| | - Kaan Masrabaci
- Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Surgery, University of Health Sciences, Istanbul, Turkey
| | - Selenay Furat Recber
- Faculty of Medicine, Department of Histology and Embryology, Kocaeli University, Izmit, Kocaeli, Turkey
| | - Yagmur Sonmez
- Sancaktepe Sehit Prof.Dr. Ilhan Varank Training and Research Hospital, Department of Pediatric Surgery, University of Health Sciences, Istanbul, Turkey
| | - Seval Aydin
- Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul University, Istanbul, Turkey
| | - Karolin Yanar
- Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul University, Istanbul, Turkey
| | - Esmanur Seker
- Cerrahpasa Faculty of Medicine, Department of Medical Biochemistry, Istanbul University, Istanbul, Turkey
| | - Yusufhan Yazir
- Stem Cell and Gene Therapies Research and Application Center, Kocaeli University, Izmit, Kocaeli, Turkey
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Akgunduz F, Sozutek A, Irkorucu O, Yaman A. The Adjunctive Effect of DuraSeal® vs. 2-Octyl-Cyanoacrylate on Delayed Repair of Gastric Perforation: An Experimental Study. J INVEST SURG 2022; 35:542-548. [PMID: 33645439 DOI: 10.1080/08941939.2021.1887414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Delayed primary suture closure of gastric perforation is prone to dehiscence hence the repaired area should be buttressed to avoid re-operation. We aimed to investigate whether DuraSeal®(DS) has a potent adjunctive effect on delayed closure of gastric perforation comparing with 2-octly-cyanoacrylate(CYN) in an experimental model. METHODS Sixty rats were randomly divided into 6 groups. All subjected to gastric perforation, subsequently perforation areas were repaired by primary suturing, delayed repair was performed 12 h after surgery. According to DS or CYN application on anastomosis, the groups were classified as control(C), delayed control(CD), closure with CYN(CYN), delayed closure with CYN(D-CYN), closure with DS(DS), delayed closure with DS(D-DS).After euthanization on POD 7,anastomotic bursting pressure(ABP) were measured. Tissue samples were taken for histopathological examination and hydroxyproline(TH) assessment. RESULTS Delayed condition significantly reduced ABP and TH levels in CD group comparing with all groups(p < 0.01).Either CYN or DS application on delayed repaired area significantly raised the measure of ABP and TH up to the levels of C group(p < 0.05,comparing with CD).Microscopically,either CYN or DS application significantly improved tissue necrosis, submucosal bridging and collagen formation comparing with CD group(p < 0.012).There were no difference regarding ABP, TH and tissue healing between each CYN and DS groups. CONCLUSION DuraSeal® application on sutured gastric perforation area yielded a significant adjunctive effect both in normal and delayed conditions. However, DuraSeal® revealed no superior effect to CYN in both condition.Our results demonstrated that the clinical use of DuraSeal® can be considered for reinforcing the sutured line in patients undergoing delayed surgery for gastric perforation.
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Affiliation(s)
- Fatih Akgunduz
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Alper Sozutek
- Gastroenterological Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Oktay Irkorucu
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
| | - Abit Yaman
- General Surgery, Health Sciences University, Adana Training and Research Hospital, Adana, Turkey
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Geropoulos G, Psarras K, Giannis D, Martzivanou EC, Papaioannou M, Kakos CD, Pavlidis ET, Symeonidis N, Koliakos G, Pavlidis TE. Platelet rich plasma effectiveness in bowel anastomoses: A systematic review. World J Gastrointest Surg 2021; 13:1736-1753. [PMID: 35070077 PMCID: PMC8727194 DOI: 10.4240/wjgs.v13.i12.1736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/11/2021] [Accepted: 11/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery. Technical insufficiency, topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage, with detrimental effects on patient postoperative outcomes. Despite the investigation of several factors and the invention of protective materials, the ideal agent to prevent anastomotic leaks is yet to be determined. AIM To study the effect of platelet rich plasma (PRP) on the healing of bowel anastomoses. METHODS A systematic literature search was performed in PubMed, EMBASE, and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis. RESULTS Eighteen studies were eligible with a total population of 712 animals including rats (14 studies), rabbits (2 studies) and pigs (2 studies). No postoperative complications were reported following PRP application. Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention, such as intraperitoneal chemotherapy or peritonitis. Similar results were reported by ten studies in terms of tissue hydroxyproline levels. One study reported significant increase in collagen deposition in PRP groups. PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy (6 studies). CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes, especially in animal models having an underlying condition affecting the normal healing process. PRP application seems to augment the normal healing process under these circumstances. However, further studies are needed to investigate the potential role of PRP on bowel anastomosis healing, especially in clinical settings.
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Affiliation(s)
- Georgios Geropoulos
- Department of General Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
| | - Kyriakos Psarras
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States
| | - Eirini Chrysovalantou Martzivanou
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Maria Papaioannou
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | | | - Efstathios Theodoros Pavlidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Nikolaos Symeonidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Georgios Koliakos
- Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
| | - Theodoros Efstathios Pavlidis
- Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
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Schiellerup NS, Wismann J, Madsen GI, Le DQS, Qvist N, Ellebæk MB. Incorporation of a Poly-ε-Caprolactone Scaffold in a ;Circular Stapled End-To-End Small Intestine Anastomosis Does Not Have Any Adverse Effects Within 30 days: A Study in Piglets. Surg Innov 2021; 28:679-687. [PMID: 33745358 DOI: 10.1177/1553350621999294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Incorporation of a poly-ε-caprolactone (PCL) scaffold in circular stapled anastomoses has been shown to increase the anastomotic tensile strength on postoperative day (POD) 5 in a pig model. The aim of this study was to investigate the effects of incorporation of a PCL scaffold in a circular stapled end-to-end small intestine anastomosis, with stricture formation and anastomotic histology as primary outcomes in a 30-day observation period. Methods. A total of 15 piglets were included. In each piglet, three circular stapled end-to-end anastomoses were made in the small intestines. Two were interventional and one was a control. On POD 10, 20, or 30, the anastomoses were subjected to in vivo intraluminal contrast study, and the index for anastomotic lumen was calculated. The anastomotic segment was resected and subjected to a tensile strength test and histological examination. Results. At POD 10, the mean ± SD value for anastomotic index was .749 ± .065 in control anastomoses and .637 ± .051 in interventional anastomosis (P = .0046), at POD 20, .541 ± .150 and .724 ± .07 (P = .051), and at POD 30, .645 ± .103 and .686 ± .057 (P = .341), respectively. No significant difference was observed in maximum tensile strength and histology at POD 30. Conclusions. The incorporation of a PCL scaffold in a circular stapled end-to-end small intestine anastomosis does not increase the risk of stricture or impair wound healing after 30 days.
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Affiliation(s)
| | - Joakim Wismann
- Department of Surgery, 11286Odense University Hospital, Odense, Denmark
| | - Gunvor I Madsen
- Department of Pathology, 573154Odense University Hospital, Odense, Denmark
| | - Dang Q S Le
- Department of Clinical Medicine, 1006Aarhus University, Aarhus C, Denmark
| | - Niels Qvist
- Department of Surgery, 11286Odense University Hospital, Odense, Denmark
- Danish Centre for Regenerative Medicine (CRM), 573154Odense University Hospital, Odense, Denmark
| | - Mark B Ellebæk
- Department of Surgery, 11286Odense University Hospital, Odense, Denmark
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Bicer A, Ercin BS, Gürler T, Yiğittürk G, Uyanikgil Y, Cetin EO. Possibility of Taking an Offensive Stance in Extravasation Injury: Effects of Fat Injection in Vesicant (Doxorubicin) Induced Skin Necrosis Model in Rats. J INVEST SURG 2021; 35:801-808. [PMID: 34402353 DOI: 10.1080/08941939.2021.1966142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Extravasation injuries are one of the most feared complications of intravenous drug administration. The most common drugs associated with extravasation injury include chemotherapy agents and contrast media. Natural course of vesicant extravasation is discomfort, pain, swelling, inflammation, and ultimately skin ulceration. While diligence is the principle approach in prevention, immediate bed-side measures are as important in controlling the extent of tissue damage. Various options, either medical or interventional are next steps in treatment of the condition including antidotes, volume dilution, flushing, suction, hyperbaric oxygen therapy, and surgery. MATERIALS AND METHODS 12 male Wistar albino rats were divided into two groups; one group received fat injections following subdermal doxorubicin infiltration in their right thighs, while other group received saline injection following subdermal doxorubicin infiltration in their right thighs for dilution. Left thighs of both groups were left untreated following subdermal doxorubicin infiltration. Total area of necrosis, as well as resultant epidermal thicknesses were assessed. Histological analyses were conducted using modified Verhofstad scoring system for comparison. RESULTS Mean necrotic area was significantly smaller in the fat injection group compared to other groups. Median Verhofstad score was lesser in the fat injection group as well. Median epidermal thickness, on the other hand, was greater in the fat injection group. CONCLUSION Injection of fat grafts following vesicant extravasation might be beneficial in preventing the progression of tissue damage, if employed early.
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Affiliation(s)
- Ahmet Bicer
- Department of Plastic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burak Sercan Ercin
- Department of Plastic, Reconstructive and Aesthetic surgery, Bahcesehir University, Istanbul, Turkey.,Department of Plastic, Reconstructive and Aesthetic surgery, Medicalpark Pendik Hospital, Istanbul, Turkey
| | - Tahir Gürler
- Department of Plastic Surgery, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gürkan Yiğittürk
- Department of Histology and Embryology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Yigit Uyanikgil
- Department of Histology and Embryology, Faculty of Medicine, Ege University, Izmir, Turkey.,Department of Stem Cell, Ege University, Health Science Institue, Izmir, Turkey.,Cord Blood, Cell and Tissue Research and Application Centre, Ege University, Izmir, Turkey
| | - Emel Oyku Cetin
- Department of Pharmaceutical Technology, Department of Biopharmaceutics and Pharmacokinetics, Faculty of Pharmacy, Ege University, Izmir, Turkey
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Hancioğlu S, Demirel BD, Biçakci Ü, Gün S, Aritürk E, Aritürk N. Histopathological and mechanical effects of Ankaferd Blood Stopper® on wound healing in rats: an experimental model. Turk J Med Sci 2020; 50:1428-1433. [PMID: 32490638 PMCID: PMC7491291 DOI: 10.3906/sag-2004-177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background/aim To evaluate the histopathological and mechanical effects of Ankaferd Blood Stopper (ABS) application on wound healing. Materials and methods A total of 24 Wistar albino rats were randomly divided into three equal groups. In each group, a 3 cm-long midline vertical skin incision was performed in the back of the rats. In Group 1, the incision was sutured primarily. In Group 2, incision was left to secondary healing. In Group 3, ABS was applied to the incision. On the 10th day, burst pressure width was measured, and rats were sacrificed. The tissue samples were examined histopathologically. Statistical analysis was conducted with IBM SPSS program. P < 0.05 was considered significant. Results The mean burst pressure widths of wound separation were 13.66 ± 0.457, 7.18 ± 2.599, and 13.66 ± 1.11 mm for Groups 1–3, respectively. The difference in burst pressure width between Groups 1 and 3 was not significant (P > 0.05) but was significant between Groups 2 and 3 (P = 0.000). The vascular proliferation median values were 1, 2, and 2, for Groups 1–3, respectively. Although the difference was significant between Groups 1 and 2 in terms of vascular proliferation score (P = 0.047), no significant difference was observed between Group 3 and others. No statistically significant difference was observed among the groups in terms of collagen score, mononuclear cell infiltration, and polymorphonuclear cell proliferation (P > 0.05). The median values of fibroblast proliferation score were 1, 2, and 3, in Groups 1–3, respectively. Fibroblast proliferation score significantly differed between Groups 1 and 3 (P = 0.003). Conclusion ABS application results in a clean wound healing that is as strong as primary repair. However, additional studies are required to evaluate the late results of increased fibroblastic activity in the early period of ABS application alone.
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Affiliation(s)
- Sertaç Hancioğlu
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Berat Dilek Demirel
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ünal Biçakci
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Seda Gün
- Department of Pathology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Ender Aritürk
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
| | - Nurşen Aritürk
- Department of Ophthalmology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey
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Gorur M, Sozutek A, Irkorucu O, Karakaya B. The influence of platelet-rich plasma (PRP) on colonic anastomosis healing impaired by intraperitoneal 5-flourouracil application. An experimental study. Acta Cir Bras 2020; 35:e202000504. [PMID: 32638844 PMCID: PMC7341987 DOI: 10.1590/s0102-865020200050000004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 03/21/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE 5-flourourasil (5-FU) is commonly used for early intraperitoneal chemotherapy in colorectal or appendiceal cancer patients with peritoneal carcinomatosis. Due to its effect, anastomosis healing can be impaired and leads to anastomotic leakage. In this study, we aimed to investigate the potential healing effect of platelet-rich plasma (PRP) on colonic anastomosis impaired by intraperitoneal 5-flourouracil application. METHODS After ten rats were sacrificed for preparing PRP, forty Wistar-albino rats were subjected to colonic anastomosis, and randomly allocated into four groups including 10 rats each. According to receiving PRP and/or 5-FU application, the groups were formed as control (C), 5-FU without PRP (CT), anastomosis with PRP (C-PRP), and 5-FU with PRP (CT-PRP). CT and CT-PRP groups also received 5-FU intraperitoneally on postoperative day 1 (POD 1). All animals were euthanized on pod 7. The body weight change, anastomotic bursting pressure (ABP), tissue hydroxiprolin (TH) and histopathological examination of each group were analyzed. RESULTS 5-FU application significantly reduced ABP levels when compared with group C, C-PRP and CT-PRP (for each comparison, p<0,01). PRP application in CT-PRP group raised the measure of ABP up to the levels of C group. Although tissue hydroxyproline levels (THL) levels of CT-PRP group were found higher than CT group, it was not significant (p=0.112). Microscopically, comparing with CT group, PRP application significantly promoted the healing of colonic anastomosis subjected to 5-FU application by improving tissue edema, necrosis, submucosal bridging and collagen formation (p<0.05). Tissue healing in CT-PRP group was observed as good as the control groups. (C, C-PRP, p=0.181, p=0.134; respectively). CONCLUSION PRP administration on colonic anastomosis significantly promotes the healing process of anastomosis in rats receiving 5-FU. This result encourages further clinical use of PRP to reduce the frequency of AL in patients receiving EPIC.
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Affiliation(s)
- Mustafa Gorur
- MD, Department of General Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey. Analysis of data, technical procedures, manuscript preparation
| | - Alper Sozutek
- PhD, Associate Professor, Division of Gastroenterological Surgery, Department of General Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey. Technical procedures, design of the study, analysis of data, manuscript preparation
| | - Oktay Irkorucu
- PhD, Professor, Department of General Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey. Analysis of data, critical revision
| | - Burak Karakaya
- MD, Department of General Surgery, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey. Acquisition of data
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Comparison of Platelet-Rich Plasma-Impregnated Suture Material with Low and High Platelet Concentration to Improve Colonic Anastomotic Wound Healing in Rats. Gastroenterol Res Pract 2020; 2020:7386285. [PMID: 32565785 PMCID: PMC7271001 DOI: 10.1155/2020/7386285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 03/14/2020] [Accepted: 04/07/2020] [Indexed: 01/27/2023] Open
Abstract
Objective This study was designed to investigate the impact of using suture material impregnated with platelet-rich plasma (PRP) in different platelet concentrations on colonic anastomotic wound healing in rats. Methods A total of 24 Sprague Dawley female rats were separated into 3 groups (n = 8 for each) including the control group (CON; standard vicryl suture repair), the low platelet concentrate PRP group (L-PRP; suture material impregnated with PRP containing average 2.7-fold (range, 2.0 to 3.1) higher amount of platelets vs. control), and the high platelet concentrate PRP group (H-PRP; suture material impregnated with PRP containing average 5.1-fold (range, 4.8 to 5.4) higher amount of platelets vs. control). Rats were sacrificed on the postoperative 7th day for analysis of colonic anastomosis region including macroscopic observation, measurement of anastomotic bursting pressure (ABP), and the hydroxyproline levels and histopathological findings in colon tissue samples. Results Total injury scores were significantly lower in the L-PRP and H-PRP groups than those in the control group (median (range) 13.00 (7.00) and 11.50 (6.00) vs. 15.50 (4.00), p < 0.05 and p < 0.01, respectively). ABP values (180.00 (49.00) vs. 124.00 (62.00) and 121.00 (57.00) mmHg, p < 0.001 for each) and tissue hydroxyproline levels (0.56 (0.37) vs. 0.25 (0.17) and 0.39 (0.10) μg/mg tissue, p < 0.001 and p < 0.05, respectively) were significantly higher in the L-PRP group as compared with those in the control and H-PRP groups. Conclusion In conclusion, our findings revealed PRP application to colonic anastomosis sutures to promote the anastomotic healing process. The platelet concentration of PRP seems to have a significant impact on the outcome with superior efficacy of L-PRP over H-PRP in terms of bursting pressures and collagen concentration at the anastomotic site.
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Göksu M, Alakuş H, Ertan S, Akgün S. Effect of platelet-rich plasma on colon anastomosis in rats in which hyperthermic intra-peritoneal chemotherapy was performed using 5-fluorouracil. ANZ J Surg 2020; 90:2290-2297. [PMID: 32436284 DOI: 10.1111/ans.15993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hyperthermic intra-peritoneal chemotherapy (HIPEC) performed in patients with peritoneal carcinomatosis has a cytotoxic effect on tumour cells. This cytotoxic effect also adversely affects the wound healing of anastomosis, which is frequently undertaken in this patient group, and causes anastomotic leakage and intestinal fistulas. Platelet-rich plasma (PRP) gel has been used in wound healing and has shown efficacy. We investigated the effect of PRP gel on colon anastomosis healing in rats treated with 5-fluorouracil (5-FU). METHODS Twenty-four rats were divided into three groups, each containing eight rats: group 1 (control) underwent colon anastomosis alone; group 2 (5-FU) underwent a colon anastomosis and HIPEC; and group 3 (5-FU + PRP) underwent a colon anastomosis and HIPEC and received topical PRP gel. The rats were sacrificed on the post-operative day 7 and the anastomotic bursting pressure (ABP) was measured. Tissue samples were obtained to measure the hydroxyproline level and investigate the histopathological changes on the anastomosis line. RESULTS ABP was higher in the control and 5-FU + PRP groups than in the 5-FU group (P = 0.009, P = 0.047). The tissue hydroxyproline levels were higher in the control and 5-FU + PRP groups than in the 5-FU group (P = 0.001, P = 0.030). The histopathological findings of the 5-FU + PRP group were better than those of the 5-FU group. CONCLUSION This study showed that the application of PRP gel to colon anastomoses increased ABP in rats treated with HIPEC using 5-FU. It also showed positive effects on anastomotic healing by increasing the tissue hydroxyproline levels on the anastomosis line and reducing the inflammatory response.
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Affiliation(s)
- Mustafa Göksu
- Department of General Surgery, Adiyaman University Training and Research Hospital, Adiyaman, Turkey
| | - Hüseyin Alakuş
- Division of Surgical Oncology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey
| | - Siraç Ertan
- Department of Pathology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey
| | - Sadık Akgün
- Department of Medical Microbiology, Adiyaman University Training and Research Hospital, Adiyaman, Turkey
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Buk OF, Ocak S, Genc B, Avcı B, Uzuner HO. Is platelet-rich plasma improves the anastomotic healing in hyperthermic intraperitoneal chemotherapy with oxaliplatin: an experimental rat study. Ann Surg Treat Res 2020; 98:89-95. [PMID: 32051817 PMCID: PMC7002883 DOI: 10.4174/astr.2020.98.2.89] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/30/2019] [Accepted: 01/04/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose Hyperthermic intraperitoneal chemotherapy (HIPEC) is a novel treatment option for peritoneal surface malignancies. Due to cytotoxic effects of chemotherapeutic agents, anastomosis healing can be impaired and lead to leakage rates higher than conventional intestinal surgery. In this experimental study, we aimed to investigate the effects of platelet-rich plasma (PRP) on colonic anastomosis in rats that received HIPEC with oxaliplatin. Methods Thirty rats were divided into 3 groups. Group 1 was determined as control group and hyperthermic saline perfusion was performed after colon anastomosis. In group 2, colon anastomosis then hyperthermic oxaliplatin perfusion was performed. In the last group, the colonic anastomosis was enhanced by PRP gel and then hyperthermic oxaliplatin perfusion was performed. All the rats were reoperated on postoperative day 7 and anastomotic bursting pressure values were recorded. Tissue samples were taken for hydroxyproline assay and histopathological examination. Results Control group had higher anastomotic bursting pressure value than group 2 and group 3 (P < 0.001). There were significant differences in anastomotic bursting pressure between groups 2 and 3 (P < 0.001). Group 2 had significantly lower hydroxyproline levels than group 3 and control group (P < 0.001). Histopathological examination revealed that PRP application reduced inflammatory response. Conclusion PRP application on colonic anastomosis improves anastomotic healing and can reduce anastomosis related complications and stoma creation; though further clinical studies are needed.
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Affiliation(s)
- Omer Faruk Buk
- Department of General Surgery, University of Healthy Sciences, Samsun Research and Training Hospital, Samsun, Turkey
| | - Sonmez Ocak
- Department of General Surgery, University of Healthy Sciences, Samsun Research and Training Hospital, Samsun, Turkey
| | - Bugra Genc
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Bahattin Avcı
- Department of Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Hatice Olger Uzuner
- Department of Pathology, University of Healthy Sciences, Samsun Research and Training Hospital, Samsun, Turkey
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Aziret M, Karaman K, Ercan M, Vargöl E, Toka B, Arslan Y, Öter V, Bostancı EB, Parlak E. Early laparoscopic cholecystectomy is associated with less risk of complications after the removal of common bile duct stones by endoscopic retrograde cholangiopancreatography. TURKISH JOURNAL OF GASTROENTEROLOGY 2019; 30:336-344. [PMID: 30945646 DOI: 10.5152/tjg.2018.18272] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIMS Several studies recommend prompt laparoscopic cholecystectomy (LC) following endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis. However, histopathological alterations in the gallbladder during this time interval and the role played by ERCP in causing these changes have not been sufficiently elucidated. To compare early period LCs with delayed LCs following common bile duct stone extraction via ERCP with regard to operation time, hospitalization period, conversion to open cholecystectomy rate, morbidity, mortality, and histopathological alterations in the gallbladder wall. MATERIALS AND METHODS A total of 85 patients were retrospectively divided into three groups: early period LC group (48-72 h; n=30), moderate period LC group (72 h-6 weeks; n=25), and delayed period LC group (6-8 weeks; n=30). RESULTS The operation time was significantly shorter, and the total number of complication rates and hospital readmission was significantly less frequent in the early period LC group (p<0.05). Ultrasound showed a significantly thicker gallbladder wall (>3 mm) in the moderate and late period LC groups than in the early period LC group (p<0.001). Culture growth was significantly higher, and fibrosis/collagen deposition in the gallbladder wall with injury to the mucosal epithelium was significantly more frequently detected by histopathological examination in the moderate and late period LC groups than in the early period LC group (p<0.05). CONCLUSION Early period LC following stone extraction by ERCP is associated with shorter operation time, fewer fibrotic changes in the gallbladder, and lower risk for the development of complications. Therefore, LC can be performed safely in the early period after ERCP.
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Affiliation(s)
- Mehmet Aziret
- Department of General Surgery, Sakarya University Trainig and Research Hospital Sakarya, Turkey
| | - Kerem Karaman
- Department of General Surgery, Sakarya University Trainig and Research Hospital Sakarya, Turkey
| | - Metin Ercan
- Department of General Surgery, Sakarya University Trainig and Research Hospital Sakarya, Turkey
| | - Erdem Vargöl
- Department of Pathology, Sakarya University Trainig and Research Hospital, Sakarya, Turkey
| | - Bilal Toka
- Department of Gastroenterology, Sakarya University Training and Research Hospital Sakarya, Turkey
| | - Yusuf Arslan
- Department of General Surgery, Sakarya University Trainig and Research Hospital Sakarya, Turkey
| | - Volkan Öter
- Department of General Surgery, Sakarya University Trainig and Research Hospital Sakarya, Turkey
| | - Erdal Birol Bostancı
- Department of General Surgery, Sakarya University Trainig and Research Hospital Sakarya, Turkey
| | - Erkan Parlak
- Department of Gastroenterology, Hacettepe University School of Medicine Ankara, Turkey
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Larsen KD, Westerholt M, Madsen GI, Le DQS, Qvist N, Ellebæk MB. Poly-ε-caprolactone scaffold for the reinforcement of stapled small intestinal anastomoses: a randomized experimental study. Langenbecks Arch Surg 2019; 404:1009-1016. [PMID: 31776655 DOI: 10.1007/s00423-019-01843-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/13/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anastomotic leakage is a severe complication in gastrointestinal surgery. Different methods have been evaluated for anastomotic reinforcement to prevent anastomotic leakage. The aim of this study was to investigate the effect of a poly-ε-caprolactone (PCL) scaffold incorporated in the staple-line, on the anastomotic strength and histological wound healing, of small intestinal anastomoses in piglets. METHOD This randomized experimental trial included 17 piglets. In each piglet, three end-to-end anastomoses were performed in the small intestine with a circular stapler, i.e. one control and two interventional anastomoses. On postoperative day 5, the anastomoses were resected and subjected to tension stretch test and histological examination. RESULTS No anastomotic leakage occurred. In the interventional anastomoses, the mean value for maximal tensile strength was 15.7 N, which was significantly higher than control anastomoses 12.7 N (p = 0.01). No statistically significant differences were found between the two groups in the histopathological parameters. CONCLUSION To conclude, this study has shown that the incorporation of a PCL scaffold in the staple-line was feasible and significantly increased the maximal tensile strength of small intestine anastomoses in piglets on postoperative day 5. The difference in histological parameters was not significantly distinct.
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Affiliation(s)
- K D Larsen
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - M Westerholt
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - G I Madsen
- Research Unit for Pathology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - D Q S Le
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark.
- Danish Centre for Regenerative Medicine (CRM), Odense University Hospital, J.B. Winsløwsvej 4, 5000, Odense, Denmark.
| | - M B Ellebæk
- Research Unit for Surgery, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Sakar A, Bilecik T, Mayir B, Oruç T. The potential effects of Ankaferd blood stopper and fibrin sealent on sleeve gastrectomy staple-line healing: An experimental study. Exp Ther Med 2019; 18:2519-2523. [PMID: 31555363 PMCID: PMC6755414 DOI: 10.3892/etm.2019.7842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/26/2019] [Indexed: 01/04/2023] Open
Abstract
Staple-line bleeding and leakage is a life-threatening complication in obese patients following laparoscopic sleeve gastrectomy. The aim of this study was to examine the potential effects of Ankaferd blood stopper (ABS) and Fibrin Sealant (FS; Tisseel®) on sleeve gastrectomy staple-line healing in an experimental animal model. A total of 30 Wistar albino female rats were divided into three groups and were subjected to sleeve gastrectomy with linear stapling. Group A (control group) had nothing administered, Group B was administered FS on the staple-line, and Group C was administered ABS on the staple-line following sleeve gastrectomy. After sacrifice on postoperative day 5, anastomotic burst pressure, tissue hydroxyproline levels and histopathological parameters were measured. The results revealed that group C had the highest mean bursting pressure level. However, the values of this parameter were not found to differ significantly between the groups (P>0.05). Group B and C had a similar hydroxyproline levels but increased compared with group A (P<0.001). Histopathological parameters were similar between the groups, except macrophage scores in group C. In the present experimental study, ABS was demonstrated to improve gastric-sleeved staple-line healing compared with FS. ABS may be used as a novel reinforcement agent in bariatric surgery.
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Affiliation(s)
- Alkan Sakar
- Department of General Surgery, Kepez State Hospital, Antalya 17110, Turkey
| | - Tuna Bilecik
- Department of General Surgery, School of Medicine, VM Mersin Medical Park Hospital, Istinye University, Mersin 33200, Turkey
| | - Burhan Mayir
- Department of General Surgery, Antalya Training and Research Hospital, Antalya 07010, Turkey
| | - Tahir Oruç
- Department of General Surgery, Antalya Training and Research Hospital, Antalya 07010, Turkey
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Could we reduce adhesions to the intra-abdominal mesh in the first week? Experimental study with different methods of fixation. Hernia 2019; 24:1245-1251. [PMID: 31338720 DOI: 10.1007/s10029-019-02005-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Adhesion formation is a major problem when a mesh is exposed to intraabodminal viscera, with potential severe complications (bowel occlusion, fistulas or abscesses). New methods for preventing adhesions from a polypropylene mesh placed intra-abdominally or to solve difficult situations, such as when the peritoneum cannot be closed during a TAPP repair for an inguinal hernia, are still being seeked. This study mimics in an animal model a situation that can be found in clinical practice during laparoscopic inguinal hernioplasty. A polypropylene mesh could be exposed to the intra-abdominal cavity even when the peritoneum is closed due to different circumstances, with no options to guarantee the prosthetic material of being exposed to the intrabdominal viscera. Different options have been suggested to solve these situations, being proposed in this study to cover the visceral surface of the mesh with an absorbable sponge containing thrombin, fibrinogen, and clotting factors (Tachosil®, Nycomed, Takeda, Osaka, Japan), to assess its use as a barrier to prevent postoperative adhesion formation. MATERIAL AND METHODS Thirty Wistar white rats (300-450 mg) were included in this study as experimental animals, being randomized into three groups (A, B, and C). We performed a bilateral prosthetic repair with conventional polypropylene mesh (2 × 2 cm, 82 kD). Prosthesis fixation was performed as follows. Group A: absorbable suture; group B: metal staples; group C: metal tackers. A piece of insulating absorbable sponge (Tachosil® 5 × 5 cm) was placed to cover the visceral surface of mesh placed at the right side of each animal. After 10 days, we performed a gross examination (by laparoscopy and laparotomy), measuring the quantity and the quality of the adhesions. Samples were taken for histopathological analysis. RESULTS Tachosil®-treated prostheses showed a statistically significant decrease in the quality of the adhesion found (p < 0.05). In addition, a smaller quantity of adhesions was identified in barrier-treated animals, although this lacked statistical significance. The histologic analysis showed no significant differences: more edema with the untreated mesh and increased angiogenesis and a lower degree of necrosis in mesh covered with Tachosil®. CONCLUSIONS The use of Tachosil® as a barrier material led to the absence of strong adhesions as it prevented direct contact between the mesh and the internal organs, preventing major problems associated with strong adhesions.
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Protective Effect of Nigella Sativa in an Animal Model of Colon Anastomosis With Ischemia/Reperfusion Injury. Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00301.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:
Anastomotic leaks are one of the chief complications after gastrointestinal surgery. The aim of this study was to evaluate whether Nigella sativa administration protects against ischemia/reperfusion injury on healing of colonic anastomosis in rats.
Method:
Thirty male Wistar albino rats, weighing between 200 and 240 g, were used in the study. They were randomly divided into three groups (n = 10 for each group): Anastomosis (group 1), anastomosis and ischemia/reperfusion injury (group 2), and treatment group of anastomosis, ischemia/reperfusion injury, and Nigella sativa (group 3). After 7 days, serum, plasma, and colonic tissue were obtained and then all rats were sacrificed. Tissue and serum level of total oxidant status, total antioxidant status, total thiol levels, hydroxyproline, interleukin-6, and TNF-alpha were determined and specimens were histopathologically evaluated.
Results:
In the Nigella sativa treated rats, serum hydroxyproline levels were significantly higher, while tissue levels were significantly lower than those seen in group 1 and group 2 (P = 0.007, P = 0.01, respectively). In the Nigella sativa group, the serum levels of TNF-α were significantly lower than those seen in group 1 and 2 (P = 0.001). Also, in group 3, the tissue IL-6 level was significantly higher than that seen in group 1 and group 2 (P = 0.009). The histopathologic analysis showed less edema and inflammatory cell infiltration in the Nigella sativa treated group, as well as a statistically significant difference according to the Chiu classification (P < 0.05).
Conclusion:
The results of this study indicate that Nigella sativa has a protective and therapeutic effect against ischemia/reperfusion injury on the healing of colonic anastomosis in rats.
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Gao Q, Wei G, Wu Y, Yao N, Zhou C, Wang K, Wang K, Sun X, Li X. Paeoniflorin prevents postoperative peritoneal adhesion formation in an experimental rat model. Oncotarget 2017; 8:93899-93911. [PMID: 29212197 PMCID: PMC5706843 DOI: 10.18632/oncotarget.21333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/28/2017] [Indexed: 11/25/2022] Open
Abstract
Although materials and modern surgical techniques have been developed to suppress postoperative adhesions, adhesion formation can still occur, and thus, a novel effective anti-adhesion drug is greatly needed. In the present study, we explored the efficacy of paeoniflorin treatment against postoperative peritoneal adhesions and examined the anti-oxidative stress and anti-inflammatory properties of PE. Forty-eight male Sprague-Dawley rats were randomly divided into 6 groups for the study: the sham, control, hyaluronan and three concentrations (10, 20 and 40 mg/kg/d) paeoniflorin groups. Abdominal adhesions were created by abrasion of the caecum and its opposite abdominal wall. In the paeoniflorin groups, the rats were administered daily oral doses of paeoniflorin for 7 days. The abdominal cavities of the rats were reopened with a U-shaped incision to macroscopically grade the adhesions. Histologic analysis was performed, and oxidative stress, inflammatory cytokine, collagen fiber degradation and cytokeratin levels were measured. Macroscopic and histopathological measurements revealed that paeoniflorin reduced peritoneal adhesion and inflammation. Notably, treatment with paeoniflorin reduced the protein levels of TGF-β1, IL-6 and COX-2. The collagen fiber fractions were distinctly lower in the PE groups than in the control group. Western blotting analyses showed that paeoniflorin increased MMP-9 and superoxide dismutase-2 protein expression and sharply reduced α-SMA and COX-2 protein expression. Peritoneal mesothelium cells were more continuous and complete in animals treated with paeoniflorin. Our study suggests that paeoniflorin can be used to ameliorate peritoneal adhesions via anti-oxidative stress and anti-inflammatory actions during the postoperative period.
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Affiliation(s)
- Qi Gao
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Guangbing Wei
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Yunhua Wu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Na Yao
- College of Nursing, Shaanxi University of Chinese Medicine, Xianyang 712046, Shaanxi, China
| | - Cancan Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Kai Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Kang Wang
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xuejun Sun
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Xuqi Li
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
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Effect of Previous Irradiation on Vascular Thrombosis of Microsurgical Anastomosis: A Preclinical Study in Rats. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 4:e1073. [PMID: 27975009 PMCID: PMC5142475 DOI: 10.1097/gox.0000000000001073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 08/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The objective of the present investigation was to compare the effect of neoadjuvant irradiation on the microvascular anastomosis in cervical bundle using an experimental model in rats. METHODS One hundred forty male Sprague-Dawley rats were allocated into 4 groups: group I, control, arterial microanastomosis; group II, control, venous microanastomosis; group III, arterial microanastomosis with previous irradiation (20 Gy); and group IV, venous microanastomosis with previous irradiation (20 Gy). Clinical parameters, technical values of anastomosis, patency, and histopathological parameters were evaluated. RESULTS Irradiated groups (III and IV) and vein anastomosis groups (II and IV) showed significantly increased technical difficulties. Group IV showed significantly reduced patency rates (7/35) when compared with the control group (0/35). Radiotherapy significantly decreased the patency rates of the vein (7/35) when compared with the artery (1/35). Groups III and IV showed significantly reduced number of endothelial cells and also showed the presence of intimal thickening and adventitial fibrosis as compared with the control group. CONCLUSION Neoadjuvant radiotherapy reduces the viability of the venous anastomosis in a preclinical rat model with a significant increase in the incidence of vein thrombosis.
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Sozutek A, Colak T, Cetinkunar S, Reyhan E, Irkorucu O, Polat G, Cennet A. The Effect of Platelet-Rich-Plasma on the Healing of Left Colonic Anastomosis in a Rat Model of Intra-Abdominal Sepsis. J INVEST SURG 2016; 29:294-301. [PMID: 26822265 DOI: 10.3109/08941939.2015.1111473] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effect of platelet-rich plasma (PRP) on the healing of colonic anastomosis in the presence of sepsis. MATERIALS AND METHOD Fifty Wistar-albino male rats were used. Ten healthy rats were euthanized to prepare PRP, the rest were subjected to colonic anastomosis and randomly allocated into four groups of 10 rats each as anastomosis without PRP (C), without PRP in sepsis (SC), anastomosis with PRP (C-PRP), and with PRP in sepsis (S-PRP). Sepsis was induced by cecal ligation and puncture procedure. All animals were euthanized on postoperative day 7. The body weight change, anastomotic bursting pressure (ABP), tissue hydroxyproline (TH) and histopathological examination of each group were analyzed by using one-way analysis of variance (ANOWA) and Tukey's HSD post-hoc test to assess the differences between the groups. RESULTS There was no statistical difference among the groups in terms of body weight changes. The ABP was measured at a mean value of 179.5 ± 10.3, 129.3 ± 14.2, 209 ± 14.4, and 167.5 ± 7.5 mm-Hg, in group C, SC, C-PRP, and S-PRP, respectively. The ABP and TH of C-PRP group was significantly higher than three groups (p < .05, for each comparison). In sepsis, PRP significantly raised the mean ABP and TH levels up to the levels of C group. Tissue regeneration was significant with increased collagen formation in C-PRP group than the other groups (p < .05). The healing effect of PRP in the presence of sepsis was significant than S-group (p < .05), while similar to C group (p = .181). CONCLUSION PRP application to colonic anastomosis promotes the healing process in rats with intra-abdominal sepsis.
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Affiliation(s)
- Alper Sozutek
- a Department of General Surgery , Adana Numune Training and Research Hospital , Adana , Turkey
| | - Tahsin Colak
- b Department of General Surgery , Mersin University Medical Faculty , Mersin , Turkey
| | - Suleyman Cetinkunar
- a Department of General Surgery , Adana Numune Training and Research Hospital , Adana , Turkey
| | - Enver Reyhan
- a Department of General Surgery , Adana Numune Training and Research Hospital , Adana , Turkey
| | - Oktay Irkorucu
- a Department of General Surgery , Adana Numune Training and Research Hospital , Adana , Turkey
| | - Gurbuz Polat
- c Department of Biochemistry , Mersin University Medical Faculty , Mersin , Turkey
| | - Ahmet Cennet
- d Department of Pathology , Adana Numune Training and Research Hospital , Adana , Turkey
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Barrera-Ochoa S, Gallardo-Calero I, Sallent A, López-Fernández A, Vergés R, Giralt J, Aguirre-Canyadell M, Velez R. New and safe experimental model of radiation-induced neurovascular histological changes for microsurgical research. Lab Anim 2016; 51:124-137. [PMID: 27357187 DOI: 10.1177/0023677216656221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim is to create a new and safe experimental model of radiation-induced neurovascular histological changes with reduced morbidity and mortality for use with experimental microsurgical techniques. Seventy-two Sprague-Dawley rats (250-300 g) were divided as follows: Group I: control group, 24 rats clinically evaluated during six weeks; Group II: evaluation of acute side-effects (two-week follow-up period), 24 irradiated (20 Gy) rats; and Group III: evaluation of subacute side-effects (six-week follow-up period), 24 irradiated (20 Gy) rats. Variables included clinical assessments, weight, vascular permeability (arterial and venous), mortality and histological studies. No significant differences were observed between groups with respect to the variables studied. Significant differences were observed between groups I vs II-III regarding survival rates and histological changes to arteries, veins and nerves. Rat body weights showed progressive increases in all groups, and the mortality rate of the present model is 10.4% compared with 30-40% in the previous models. In conclusion, the designed model induces selective changes by radiotherapy in the neurovascular bundle without histological changes affecting the surrounding tissues. This model allows therapeutic experimental studies to be conducted, including the viability of microvascular and microneural sutures post radiotherapy in the cervical neurovascular bundle.
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Affiliation(s)
- Sergi Barrera-Ochoa
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,2 Hand and Microsurgery Unit, ICATME-Hospital Universitari Quiron-Dexeus, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Irene Gallardo-Calero
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Andrea Sallent
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Alba López-Fernández
- 3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ramona Vergés
- 4 Radiotherapy Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Jordi Giralt
- 4 Radiotherapy Department, Hospital Universitari Vall Hebron, Barcelona, Spain
| | - Marius Aguirre-Canyadell
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Roberto Velez
- 1 Orthopedic Surgery Department, Hospital Universitari Vall Hebron, Barcelona, Spain.,3 Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
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Sozutek A, Ozyazici S, Colak T, Cetınkunar S, Irkorucu O, Bobusoglu O, Cennet A. Evaluating the effect of infliximab on the healing of left colonic anastomosis in the presence of intra-abdominal sepsis. Arab J Gastroenterol 2016; 17:84-89. [PMID: 27426959 DOI: 10.1016/j.ajg.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 05/17/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND STUDY AIMS Infliximab (IFX) is a chimeric anti-TNF-α body which is effectively used in the treatment of inflammatory bowel diseases and a variety of autoimmune diseases. The effect of IFX on the healing of intestinal anastomosis has been evaluated in several studies, however with conflicting results. Furthermore, the effect of IFX on colonic anastomosis in sepsis has not been evaluated to date. In this study, we aimed to investigate whether IFX has an adverse effect on the healing process of colonic anastomosis either under normal or septic condition. MATERIAL AND METHOD The efficiency of IFX was assessed with respect to anastomotic bursting pressure (ABP), tissue hydroxyproline levels (THL) and histopathological examination of left colonic anastomosis in 40 male rats. The rats were randomly allocated into four groups of 10 rats each as control (C), septic control (SC), control IFX (C-IFX) and septic IFX (S-IFX). RESULTS The anastomotic bursting pressure was measured at 182±19.1, 158±15.4, 161±26.8 and 100±10.3mm/Hg, in C, SC, C-IFX and S-IFX; respectively. IFX administration did not influence the anastomotic strength under normal condition whereas in sepsis significantly induced the reduction of APB. The mean THL was almost similar in both control groups (p=0.87), whilst IFX reduced the level of TH in sepsis comparing with control groups (p=0.01). IFX significantly impaired immune response in sepsis resulting in poor anastomotic healing in S-IFX group. CONCLUSION Our study demonstrated that IFX had no detrimental effect on the healing of colonic anastomosis under normal condition whilst significantly impaired the healing process in sepsis.
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Affiliation(s)
- Alper Sozutek
- Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey.
| | - Sefa Ozyazici
- Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey
| | - Tahsin Colak
- Mersin University Medical Faculty, Department of General Surgery, Mersin, Turkey
| | - Suleyman Cetınkunar
- Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey
| | - Oktay Irkorucu
- Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey
| | - Onur Bobusoglu
- Mersin University Medical Faculty, Department of Biochemistry, Mersin, Turkey
| | - Ahmet Cennet
- Adana Numune Training and Research Hospital, Department of Pathology, Adana, Turkey
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Willems MC, Hendriks T, Lomme RM, de Man BM, van der Vliet JA. The Effect of Mycophenolate Mofetil on Early Wound Healing in a Rodent Model. Transplant Direct 2016; 2:e80. [PMID: 27500270 PMCID: PMC4946522 DOI: 10.1097/txd.0000000000000591] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 03/30/2016] [Indexed: 01/11/2023] Open
Abstract
Background Immunosuppressant agents are inevitable for solid organ recipients, but may have a negative effect on wound healing that is difficult to measure because of clinical use of a polydrug regime. The evidence on mycophenolate mofetil (MMF) is scarce and contradictory. This study aims to investigate the effect of MMF administration on wound healing. Methods Ninety-six male Wistar rats divided into 4 groups underwent anastomotic construction in ileum and colon at day 0. Three groups received daily oral doses of 20 or 40 mg/kg MMF or saline (control group) from day 0 until the end of the experiment. Half of each group was analyzed after 3 days and half after 7 days. Another group started the medication 3 days after the laparotomy and was analyzed after 7 days, half of this group received 20 mg/kg and half 40 mg/kg MMF. Wound strength in anastomoses and in the abdominal wall was measured using bursting pressure, breaking strength, and histology. Trough levels were measured. Results Significant differences in wound strength were seen in ileum tissue after 3 days, which surprisingly showed a stronger anastomosis in the experimental groups. Bursting pressure as well as breaking strength was higher in the low-dose and high-dose MMF group compared with the control group. A negative effect was measured in abdominal wall tissue for the highest-dose group, which disappeared when the medication was delayed for 3 days. Histology showed poorer bridging of the submucosal layer and more polymorphonuclear cell infiltration in the ileum specimens of the control group compared with the treatment groups. Conclusions As a single agent in a preclinical wound healing model in the rat, MMF has no negative effect on healing of bowel anastomoses but might have a negative effect on the healing of abdominal wall.
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Affiliation(s)
- Martine Cm Willems
- Division of Vascular and Transplantation Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Thijs Hendriks
- Division of Vascular and Transplantation Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Roger Mlm Lomme
- Division of Vascular and Transplantation Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ben M de Man
- Division of Vascular and Transplantation Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Adam van der Vliet
- Division of Vascular and Transplantation Surgery, Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
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Habibi M, Oner OZ, Oruc MT, Bulbuller N, Ozdem S, Ozdemir S, Alikanooglu AS, Karakoyun R, Dogan U, Ongen A, Koc U. Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model. Ann Coloproctol 2015; 31:213-21. [PMID: 26817016 PMCID: PMC4724702 DOI: 10.3393/ac.2015.31.6.213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/16/2015] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model. METHODS Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis. RESULTS Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined. CONCLUSION Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.
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Affiliation(s)
- Mani Habibi
- Department of General Surgery, Esenler Maternity and Child Health Hospital, Istanbul, Turkey
| | - Osman Zekai Oner
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Mehmet Tahir Oruc
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Nurullah Bulbuller
- Department of General Surgery, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Sebahat Ozdem
- Department of Biochemistry, Akdeniz University, School of Medicine, Antalya, Turkey
| | - Sukru Ozdemir
- Department of General Surgery, Karapınar State Hospital, Konya, Turkey
| | | | - Rojbin Karakoyun
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ugur Dogan
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Ayper Ongen
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
| | - Umit Koc
- Department of General Surgery, Antalya Training and Research Hospital, Antalya, Turkey
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Turkoglu M, Bostancı EB, Bilgili H, Türkoğlu Y, Karadeniz Ü, Aydoğ G, Erçin U, Bilgihan A, Özer İ, Akoğlu M. Effect of intraoperative PEEP application on colonic anastomoses healing: An experimental animal study. Int Surg 2015; 101:24-34. [PMID: 26215540 DOI: 10.9738/intsurg-d-15-00160.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
PURPOSE This study aimed to assess the effect of intraoperative PEEP intervention on the healing of colonic anastomoses in rabbits. MATERIALS AND METHODS Thirty-two New Zealand type male rabbits were divided into two groups of sixteen animals each. Following ventilation with tracheostomy, colonic resection and anastomosis were performed in both groups. While 10 cm H2O PEEP level was applied in Group I (PEEP), Group II (ZEEP) was ventilated without PEEP throughout the surgery. Half of the both PEEP and ZEEP group animals were killed on the third postoperative day, while the remaining half on the seventh. Anastomotic bursting pressures, the tissue concentrations in hydroxyproline, and histological assessments were performed. Besides, intraoperative oxygen saturation and postoperative arterial blood gas parameters were also compared. RESULTS On the first postoperative day, both arterial oxygen tension (PO2) and oxygen saturation (SO2) in the PEEP group were significantly higher than in the ZEEP group. On the seventh postoperative day, the bursting pressures of the anastomoses were significantly higher in the PEEP group, however the hydroxyproline content was significantly lower in the PEEP group than that in the ZEEP group. At day 7, PEEP group was significantly associated with increased neoangiogenesis compared with the ZEEP group. CONCLUSION The anastomotic healing process is positively influenced by the intraoperative PEEP application.
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Affiliation(s)
- Mehmet Turkoglu
- Akdeniz University, Faculty of Medicine, Antalya, 07058, Turkey
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Strebel K, Nielsen SRH, Biagini M, Qvist N. Effect of Humira® on Intestinal Anastomotic Response in Rabbits. J INVEST SURG 2015; 28:167-172. [PMID: 26065592 DOI: 10.3109/08941939.2014.995244] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIM The aim of this study was to compare the strength and degree of inflammation in small intestinal anastomoses in rabbits after repeated preoperative treatment with the TNF-α antibody, adalimumab (Humira®), compared to placebo. METHOD Thirty-three New Zealand white female rabbits were randomized to three weeks of weekly subcutaneous injections of adalimumab (n = 24) or placebo (n = 9). After this treatment regime, two end to end anastomoses were performed in the ileum. Following euthanasia on postoperative day 5 the anastomoses were evaluated for minimal tensile strength (MITS) and histological parameters of wound healing using a modified Verhofstad Scale. RESULTS There were no statistically significant differences between the adalimumab and placebo groups in terms of MITS or histological parameters. Multiple regression analyzes revealed that there was no association between MITS and treatment, numbers of sutures, length of surgery, preoperative weight gain, postoperative weight loss or histological score. On the day of surgery the median serum concentration of adalimumab was 5.4 μg/ml (3.4-8.6). CONCLUSION Repeated preoperative treatment with adalimumab had no significant influence on MITS or histological score in anastomoses in the small intestine of the rabbits.
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Jensen JS, Petersen NB, Biagini M, Bollen P, Qvist N. Infliximab treatment reduces tensile strength in intestinal anastomosis. J Surg Res 2015; 193:145-152. [PMID: 25156230 DOI: 10.1016/j.jss.2014.07.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 05/11/2014] [Accepted: 07/10/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The antitumor necrosis factor (infliximab [IFX]) has gained widespread use in the treatment of inflammatory bowel disease. However, several patients must undergo surgical treatment due to treatment failure and there is a potential risk that preoperative IFX treatment may have a negative effect on the healing process in intestinal anastomosis. The objective of this study was to examine the effect of repeated IFX treatment on anastomotic strength and degree of inflammation in the anastomotic line in the small intestine of rabbits. METHODS Thirty-two rabbits were randomized (2:1) to receive either repeated IFX treatment or placebo. On day 15, three separate end-to-end anastomoses were performed on the jejunum. On postoperative day 5, tensile strength and bursting pressure for the anastomoses were tested and histologic changes examined. RESULTS We found a significantly reduced tensile strength in the IFX group (1.94 ± 0.44 N) compared with the placebo group (3.33 ± 0.39 N), (P < 0.001). Calculation of Spearman correlation coefficients showed a positive significant correlation between minimal tensile strength and serum values of IFX (coefficient = -0.63; P = 0.003) as well as number of sutures in the tested anastomosis (coefficient = 0.51; P = 0.024). The general histologic score was significantly higher in the placebo group (5.00 ± 1.26 versus 3.31 ± 1.65, P = 0.03). CONCLUSIONS Repeated high-dose IFX treatment reduces tensile strength significantly in rabbits and should be investigated further as a potential risk factor of anastomotic dehiscence in inflammatory bowel disease surgery.
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Affiliation(s)
| | | | - Matteo Biagini
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Peter Bollen
- Biomedical Laboratory, Faculty of Health Science, University of Southern Denmark, Odense Denmark
| | - Niels Qvist
- Department of Surgery A, Odense University Hospital, Odense, Denmark.
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Erginel B, Erginel T, Aksoy B, Dokucu Aİ. Effect of Ozone Therapy (OT) on Healing of Colonic Anastomosis in a Rat Model of Peritonitis. Balkan Med J 2014; 31:249-53. [PMID: 25337422 DOI: 10.5152/balkanmedj.2014.13215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 07/23/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ozone is a three-oxygen molecule (O3). Ozone therapy (OT) is systematically effective when pathological inflammatory and immunologic processes are activated. Among of these conditions are wound healing, macular degeneration related to aging, and conditions that are ischemic or infectious. AIMS The aim of this study was to determine the effects of OT on wound healing of intestinal anastomosis in the presence of peritonitis in a rat model. STUDY DESIGN Animal experimentation. METHODS A total of 40 Wistar albino rats were randomized into four groups (n=10) including: sham (S), peritonitis (P), ozone 0 (O0), and ozone 24 (O24). In group S, only cecal dissection was carried out. The S group had only a cecal dissection and intestinal anastomosis performed, but no peritonitis. In all other groups, cecal ligation and puncture (CLP) followed the cecal dissection to induce bacterial peritonitis. 24 h after puncture, a cecal resection and ileocolic anastomosis were performed. In group P, 24 h after CLP, a cecal resection and ileocolic anastomosis were performed and no ozone was administered. In group O0, immediately after the anastomosis, and in group O24, starting 24 hours after the anastomosis, an intraperitoneal 1 mg/kg/day ozone administration was applied for seven days. On the seventh day the animals were sacrificed, the anastomotic bursting pressures (BP) and the hydroxyproline values of the anastomotic tissues were measured, and histopathologic examination of the anastomotic segment was carried out. RESULTS The highest BP was in group S, with 211±23.13 mmHg. The mean BP of group P was 141±56.25 mmHg, which was significantly lower than in the other two peritonitis groups that received ozone therapy, group O0 and O24, where it was 192±22 and 166±45 mmHg, respectively (p<0.05). The difference in the BP between groups O0 and O24 was not statistically significant (p>0.05). Histopathologic analyses of the anastomotic segments determined there was significantly more oedema and necrosis in the control group rats, and collagen deposition in the anastomotic tissue was significantly higher in the ozone-treated groups on postoperative day 7. Hydroxyproline levels were significantly higher in groups O0 and O24 compared to the peritonitis group (P). CONCLUSION Ozone therapy has a beneficial effect on anastomotic healing of the colon in the presence of peritonitis.
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Affiliation(s)
- Başak Erginel
- Department of Pediatric Surgery, İstanbul Şişli Etfal Training and Research Hospital, İstanbul, Turkey
| | - Turgay Erginel
- Department of General Surgery, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Bilgin Aksoy
- Department of Pathology, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Ali İhsan Dokucu
- Department of Pediatric Surgery, İstanbul Şişli Etfal Training and Research Hospital, İstanbul, Turkey
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Mohsenifar Z, Feridoni MJ, Bayat M, Masteri Farahani R, Bayat S, Khoshvaghti A. Histological and biomechanical analysis of the effects of streptozotocin-induced type one diabetes mellitus on healing of tenotomised Achilles tendons in rats. Foot Ankle Surg 2014; 20:186-191. [PMID: 25103706 DOI: 10.1016/j.fas.2014.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/29/2014] [Accepted: 04/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tendon healing is impaired in patient with diabetes mellitus. The effects of streptozotocin-induced type 1 diabetes (STZ-D) on the healing of the transected Achilles tendon in rats was studied. METHODS In the experimental group, type one diabetes was induced via administration of STZ. The right Achilles tendon of all the rats was transected 30 days after the STZ administration. The Achilles tendons were examined for biomechanical and histological examinations. RESULTS The statistical analysis showed that Young's modulus of elasticity and stress tensile load of the control group were significantly higher than those of the experimental group, and inflammation in the experimental group was significantly higher than that in the control group. At the same time, fibrosis in the experimental group was significantly lower than that of the control group. CONCLUSION Induction of type 1 diabetes by STZ significantly delayed the healing of the transected Achilles tendon in rats.
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Affiliation(s)
- Zhaleh Mohsenifar
- Pathology Department, Ayatallah Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Mohammad Javad Feridoni
- Anatomy and Biology Department, Medical Faculty, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Mohammad Bayat
- Anatomy and Biology Department, Medical Faculty, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran.
| | - Reza Masteri Farahani
- Anatomy and Biology Department, Medical Faculty, Shahid Beheshti University of Medical Sciences, Tehran 1985717443, Iran
| | - Shiva Bayat
- Shiraz University of Medical Sciences, Shiraz, Iran
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Impact of intraoperative temperature and humidity on healing of intestinal anastomoses. Int J Colorectal Dis 2014; 29:469-75. [PMID: 24468796 DOI: 10.1007/s00384-014-1832-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Clinical data indicate that laparoscopic surgery has a beneficial effect on intestinal wound healing and is associated with a lower incidence of anastomotic leakage. This observation is based on weak evidence, and little is known about the impact of intraoperative parameters during laparoscopic surgery, e.g., temperature and humidity. METHODS A small-bowel anastomosis was formed in rats inside an incubator, in an environment of stable humidity and temperature. Three groups of ten Wistar rats were operated: a control group (G1) in an open surgical environment and two groups (G2 and G3) in the incubator at a humidity of 60 % and a temperature of 30 and 37 °C (G2 and G3, respectively). After 4 days, bursting pressure and hydroxyproline concentration of the anastomosis were analyzed. The tissue was histologically examined. Serum levels of C-reactive-protein (CRP) were measured. RESULTS No significant changes were seen in the evaluation of anastomotic stability. Bursting pressure was very similar among the groups. Hydroxyproline concentration in G3 (36.3 μg/g) was lower by trend (p = 0.072) than in G1 (51.7 μg/g) and G2 (46.4 μg/g). The histological evaluation showed similar results regarding necrosis, inflammatory cells, edema, and epithelization for all groups. G3 (2.56) showed a distinctly worse score for submucosal bridging (p = 0.061) than G1 (1.68). A highly significant increase (p = 0.008) in CRP was detected in G3 (598.96 ng/ml) compared to G1 (439.49 ng/ml) and G2 (460 ng/ml). CONCLUSION A combination of high temperature and humidity during surgery induces an increased systemic inflammatory response and seems to be attenuating the early regeneration process in the anastomotic tissue.
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Adipose-derived stem cells enhance tissue regeneration of gastrotomy closure. J Surg Res 2013; 185:945-52. [DOI: 10.1016/j.jss.2013.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/26/2013] [Accepted: 05/03/2013] [Indexed: 01/06/2023]
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Krarup PM, Eld M, Heinemeier K, Jorgensen LN, Hansen MB, Ågren MS. Expression and inhibition of matrix metalloproteinase (MMP)-8, MMP-9 and MMP-12 in early colonic anastomotic repair. Int J Colorectal Dis 2013; 28:1151-9. [PMID: 23619615 DOI: 10.1007/s00384-013-1697-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Submucosal collagen is paramount for colonic anastomotic integrity. Matrix metalloproteinases (MMPs) mediate collagen degradation that increases the risk of wound dehiscence. Although broad-spectrum MMP inhibitors are beneficial for anastomotic strength, they can cause adverse reactions. Knowledge of specific MMPs responsible for the weakening of anastomoses can be used to optimise MMP inhibition therapy. We aimed to quantify transcript and protein levels of multiple MMPs in colonic anastomoses and evaluate the effect of inhibiting the MMPs that displayed the highest expression levels on anastomotic repair. METHODS Left-sided colonic anastomoses were made in male Sprague-Dawley rats. After 3 days when biomechanical strength is lowest, MMP mRNA and protein levels were measured by quantitative real-time polymerase chain reaction, enzyme-linked immunosorbent assays and gelatin zymography. The effects of the MMP-8, MMP-9 and MMP-12 synthetic inhibitor AZD3342 was also studied. RESULTS MMP-8, MMP-9 and MMP-12 gene and protein expression increased profoundly (p < 0.01), and MMP-13 mRNA and MMP-2 mRNA and protein modestly (p < 0.001) in the anastomoses. MMP-3 mRNA levels were not up-regulated significantly compared with adjacent uninjured colon. Increased anastomotic MMP-12 levels paralleled macrophage infiltration by immunohistochemical analyses. AZD3342 (50 mg/kg) treatment increased the anastomotic breaking strength by 29% (p = 0.015) day 3 compared with vehicle. Improved anastomotic strength was not accompanied with alterations of type I or type III procollagen mRNA but was possibly due to inhibition of the concerted digestive action on the existent submucosal collagens by the targeted MMPs. CONCLUSION The present findings justify the concept of selective MMP inhibition to enhance anastomotic strength in colon.
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Affiliation(s)
- Peter-Martin Krarup
- Department of Surgery K, Bispebjerg Hospital, Bispebjerg Bakke 23, DK 2400 Copenhagen NV, Denmark.
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Kulemann B, Timme S, Seifert G, Holzner PA, Glatz T, Sick O, Chikhladze S, Bronsert P, Hoeppner J, Werner M, Hopt UT, Marjanovic G. Intraoperative crystalloid overload leads to substantial inflammatory infiltration of intestinal anastomoses-a histomorphological analysis. Surgery 2013; 154:596-603. [PMID: 23876362 DOI: 10.1016/j.surg.2013.04.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 04/03/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND It has been shown that crystalloid fluid-overload promotes anastomotic instability. As physiologic anastomotic healing requires the sequential infiltration of different cells, we hypothesized this to be altered by liberal fluid regimes and performed a histomorphological analysis. METHODS 36 Wistar rats were randomized into 4 groups (n=8-10 rats/group) and treated with either liberal (+) or restrictive (-) perioperative crystalline (Jonosteril = Cry) or colloidal fluid (Voluven = Col). Anastomotic samples were obtained on postoperative day 4, routinely stained and histophathologically reviewed. Anastomotic healing was assessed using a semiquantitative score, assessing inflammatory cells, anastomotic repair and collagenase activity. RESULTS Overall, the crystalloid overload group (Cry (+)) showed the worst healing score (P < 0.01). A substantial increase of lymphocytes and macrophages was found in this group compared to the other three (P < 0.01). Both groups that received colloidal fluid (Col (+) and Col (-)) as well as the group that received restricted crystalloid fluid resuscitation (Cry (-)) had better intestinal healing. Collagenase activity was significantly higher in the Cry (+) group. CONCLUSION Intraoperative infusion of high-volume crystalloid fluid leads to a pathological anastomotic inflammatory response with a marked infiltration of leukocytes and macrophages resulting in accelerated collagenolysis.
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Affiliation(s)
- Birte Kulemann
- Department of General and Visceral Surgery, University Hospital Freiburg, Freiburg, Germany.
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The effects of Pycnogenol(®) on colon anastomotic healing in rats given preoperative irradiation. Int J Surg 2013; 11:983-8. [PMID: 23791893 DOI: 10.1016/j.ijsu.2013.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/05/2013] [Indexed: 01/15/2023]
Abstract
Pycnogenol(®) has excellent radical scavenging properties and enhances the production of antioxidative enzymes which contributes to the anti-inflammatory effect of the extract. Irradiation delivered to the abdominal region, typically results in severe damage to the intestinal mucosa. The effects of ionizing radiation are mediated by the formation of free radicals through radiolysis. Irradiation has local effects on tissues. These local effects of irradiation on the bowel are believed to involve a two-stage process which includes both short and long term components. In our study we aimed to investigate the short term effects of Pycnogenol(®) on the healing of colon anastomoses in irradiated bowel. Sixty male Wistar-Albino rats were used in this study. There were three groups: Group I, control group (n = 20); group II which received preoperative irradiation (n = 20); group III which received per oral Pycnogenol(®) before irradiation (n = 20). Only segmeter colonic resection and anastomosis was performed to the control group (Group I). The other groups (Group II, III) underwent surgery on the 5th day after pelvic irradiation. On postoperative days 3 and 7, half of the rats in each group were sacrificed and then relaparotomy was performed. There was no statistical difference between groups with respect to biochemical parameters. Bursting pressure was significantly higher in the Control and Group III compared with the Group II. In conclusion, the present study showed that preoperative irradiation effect negatively on colonic anastomoses in rats by means of mechanical parameters and administration of Pycnogenol(®) preoperatively ameliorates this unfavorable effect.
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Daams F, Monkhorst K, van den Broek J, Slieker JC, Jeekel J, Lange JF. Local ischaemia does not influence anastomotic healing: an experimental study. ACTA ACUST UNITED AC 2013; 50:24-31. [PMID: 23548268 DOI: 10.1159/000348411] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 01/28/2013] [Indexed: 12/19/2022]
Abstract
The role of local ischaemia in the pathogenesis of colorectal anastomotic leakage (AL) is not known. This study investigates the role of local ischaemia caused by sutures in an experimental colonic anastomosis model. 36 mice were assigned to three types of anastomosis, all using running sutures; in the first group 5 stitches were used, in the second group 12 stitches were used, and in the third group at least 30 stitches were used. After 7 days the mice were re-operated, signs of AL were scored, and coronal sections of the anastomosis were histologically analyzed. The distribution of weight was not significantly different between the three groups. Mortality was 44% and not significantly different between the groups (group 1: 5/12, group 2: 4/12, and group 3: 7/12, p = 0.72). Faecal and purulent AL were observed in 6 animals in group 1, 2 in group 2, and 3 in group 3 (group 1: 50%, group 2: 17%, and group 3: 25%, p = 0.19). The distance between the two colonic edges (group 1: 0.51 μm, group 2: 1.34 μm, and group 3: 0.53 μm, p = 0.18), the diameter of the lumen at the site of the anastomosis (group 1: 2.92 μm, group 2: 4.06 μm, and group 3: 3.2 μm, p = 0.9), and the largest diameter of the lumen proximally to the anastomosis (group 1: 2.05 μm, group 2: 3.1 μm, and group 3: 2.6 μm, p = 0.25) were not different between the groups. Histological parameters of wound healing were not significantly different for the three groups. In this study no macroscopic and microscopic differences were observed between colon anastomosis with 5 stitches versus 12 and >30 stitches. This might indicate that local ischaemia does not negatively influence colonic wound healing.
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Affiliation(s)
- F Daams
- Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Teke Z, Bostanci EB, Yenisey C, Kelten EC, Sacar S, Simsek NG, Duzcan SE, Akoglu M. Effects of caffeic acid phenethyl ester on anastomotic healing in secondary peritonitis. J INVEST SURG 2013; 25:301-10. [PMID: 23020270 DOI: 10.3109/08941939.2011.646450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We aimed to investigate the effects of caffeic acid phenethyl ester (CAPE) on wound healing in left colonic anastomoses in the presence of intraperitoneal sepsis induced by cecal ligation and puncture (CLP) in a rodent model. METHODS This experimental study was conducted on 48 male Wistar albino rats. The animals were randomly allocated into four groups and a left colonic anastomosis was performed on the day following sham operation or CLP in all rats: (i) sham-operated control group, laparatomy plus cecal mobilization (n = 12) (Group 1), (ii) sham + CAPE group, identical to Group 1 except for CAPE treatment (10 μmol/kg, intraperitoneally, 30 min before construction of the colonic anastomosis) (n = 12) (Group 2), (iii) CLP group, cecal ligation and puncture (n = 12) (Group 3), and (iv) CLP + CAPE-treated group, 10 μmol/kg, intraperitoneally, 30 min before the construction of colonic anastomosis (n = 12) (Group 4). On the postoperative day 7, the animals were subjected to relaparotomy for in-vivo measurement of the colonic anastomotic bursting pressure. A colonic segment including the anastomotic site was resected for histopathological evaluation and biochemical analyses of hydroxyproline (Hyp) contents, myeloperoxidase (MPO) acivity, malondialdehyde (MDA) levels, reduced glutathione (GSH) levels, and superoxide dismutase (SOD) activity. Body weight changes were examined. RESULTS CAPE treatment significantly increased colonic anastomotic bursting pressures (p < .05), colonic anastomotic tissue Hyp contents, and enzymatic and nonenzymatic antioxidant markers (p < .05), and significantly decreased oxidative stress parameters in colonic anastomotic tissues (p < .05). Histopathological scores were significantly better by CAPE administration (p < .05). CONCLUSION This study clearly showed that CAPE treatment prevented the detrimental effects of intraperitoneal sepsis on colonic anastomotic wound healing. Further clinical studies are required to determine whether CAPE has a useful role in the enhancement of gastrointestinal anastomotic wound healing during particular surgeries in which sepsis-induced organ injury occurs.
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Affiliation(s)
- Zafer Teke
- Department of Gastroenterological Surgery, Turkey Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey. zteke
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Ploug T, Andersen K, Hansen K, Hjelmborg J, Qvist N. Influence of adalimumab treatment on anastomotic strength, degree of inflammation, and collagen formation: an experimental study on the small intestine of rabbits. Inflamm Bowel Dis 2013; 19:254-258. [PMID: 23334398 DOI: 10.1097/mib.0b013e318281007c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Adalimumab is a TNF-α inhibitor, which has gained wide use in the treatment of inflammatory bowel diseases. The potential detrimental effect of TNF-α inhibitors on postoperative complications such as anastomotic leakage is unknown. The aim of this study was to investigate the effect of a single therapeutic dose of adalimumab on anastomotic strength inflammation and collagen formation. METHODS Twenty-eight female rabbits (1.8-2.2 kg) were allocated to subcutaneous injection with either adalimumab (1.5 mg/kg) (n=14) or placebo (n=14). One week after medication two separate end-to-end anastomoses were performed in the jejunum. The rabbits were killed on the third postoperative day. The anastomosis were subjected to tensile strength analysis and histopathological examination. RESULTS No statistically significant differences were found between the two groups regarding maximum tensile strength, inflammation parameters and collagen formation in the anastomosis area. Multiple regression analysis showed no association between maximum tensile strength histological changes, time under anaesthesia, duration of surgery, weight gain, weight loss and number of sutures in either group. CONCLUSION We found no statistically significant effect of a single therapeutic dose of adalimumab on anastomotic strength, histological parameters or collagen formation in rabbits.
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Affiliation(s)
- Thomas Ploug
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
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Teke Z, Bostanci EB, Yenisey C, Kelten EC, Sacar M, Simsek NG, Duzcan SE, Akoglu M. Caffeic acid phenethyl ester prevents detrimental effects of remote ischemia-reperfusion injury on healing of colonic anastomoses. J INVEST SURG 2012; 26:16-29. [PMID: 22646141 DOI: 10.3109/08941939.2012.687434] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE We aimed to investigate whether caffeic acid phenethyl ester (CAPE) prevents detrimental systemic effects of intestinal ischemia-reperfusion (IR) injury on colonic anastomotic wound healing. METHODS This experimental study was conducted on 48 male Wistar albino rats. The rats were randomly allocated into four groups and a left colonic anastomosis was performed in all rats: (i) sham-operated group (n = 12), laparatomy without intestinal IR injury; (ii) sham + CAPE group (n = 12), identical to Group 1 except for CAPE treatment (10 μmol/kg, intravenously); (iii) intestinal IR group (n = 12), 60 min of superior mesenteric ischemia followed by reperfusion; and (iv) IR + CAPE-treated group (n = 12) (10 μmol/kg, intravenously, 30 min before the construction of colonic anastomosis). On the postoperative day 7, the rats were subjected to relaparotomy for in vivo measurement of the colonic anastomotic bursting pressure. A colonic segment including the anastomotic site was resected for histopathological evaluation and biochemical analyses. The plasma proinflammatory cytokine levels were measured. Body weight changes were examined. RESULTS CAPE treatment significantly increased colonic anastomotic bursting pressures, and colonic anastomotic tissue hydroxyproline contents and antioxidant parameters (p < .05), and significantly decreased oxidative stress markers in colonic anastomotic tissues and plasma proinflammatory cytokine levels (p < .05). Histopathological scores were significantly better due to CAPE administration (p < .05). CONCLUSIONS This study clearly showed that CAPE treatment prevented the delaying effects of remote IR injury on colonic anastomotic wound healing. Further clinical studies are required to determine whether CAPE has a useful role in the enhancement of gastrointestinal anastomotic wound healing during particular surgeries in which IR-induced organ injury occurs.
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Affiliation(s)
- Zafer Teke
- Department of Gastroenterological Surgery, Turkey Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey.
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Karaman K, Bostanci EB, Dincer N, Ulas M, Ozer I, Dalgic T, Ercin U, Bilgihan A, Ginis Z, Akoglu M. Effects of thyroid hormone supplementation on anastomotic healing after segmental colonic resection. J Surg Res 2011; 176:460-7. [PMID: 22316672 DOI: 10.1016/j.jss.2011.11.1015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Revised: 10/23/2011] [Accepted: 11/18/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alterations of thyroid hormones in colorectal surgery were previously studied. The aim of the present study was to determine the effects of triiodothyronine (T3) supplementation on anastomotic healing after segmental colectomy. MATERIAL AND METHODS Thirty male Wistar albino rats were divided into sham (n = 6), control (n = 12), and experimental (n = 12) groups. Sham group rats were immediately sacrificed after segmental colonic resection. Control and experimental group rats underwent resection and anastomosis. Experimental group rats received a single dose of T3 (400 μg/100 g) in postoperative day 1. Half of both control and experimental group rats were sacrificed on postoperative d 3 and the remaining half were sacrificed on postoperative d 7. Hydroxiproline (HP), myeloperoxidase (MPO), thyroid stimulating hormone (TSH), free T3 (FT3), and free thyroxine (FT4) levels, bursting pressure, and histologic analyses of the anastomotic segments were compared. RESULTS FT3 levels significantly decreased in control groups rats compared with the sham group (P < 0.01). However, T3 hormone given rats had no decline in FT3 levels. Anastomotic bursting pressure was significantly higher in the experimental group rats on postoperative d 7 (P = 0.015). Histopathologic analyses of the anastomotic segments determined significantly more severe edema and necrosis in control group rats (P < 0.05). Collagen deposition in the anastomotic tissue was significantly higher in experimental group rats on postoperative d 7 (P = 0.015). CONCLUSION Anastomosis after colon resection is associated with decreased FT3 level. T3 supplementation ameliorates the reduction in FT3 and seems to provide constructive therapeutic effects on anastomotic healing.
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Affiliation(s)
- Kerem Karaman
- Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Teaching and Research Hospital, Ankara, Turkey.
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Ozel Turkcu U, Cakmak GK, Demir EO, Bakkal H, Oner MO, Okyay RD, Bassorgun IC, Ciftcioglu MA. The effect of erythropoietin on anastomotic healing of irradiated rats. J INVEST SURG 2011; 25:127-35. [PMID: 22149012 DOI: 10.3109/08941939.2011.611583] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM The aim of the present study is to evaluate the possible protective effects of erythropoietin (EPO) on anastomotic wound healing after preoperative radiotherapy according to its pleiotropic mechanism of action. METHODS Thirty-two male Wistar albino rats were randomized into four groups containing eight rats each: ANAS group, standard resection plus anastomosis; RT+ANAS group, radiation plus standard resection plus anastomosis; ANAS+EPO group, standard resection plus anastomosis plus EPO; RT+ANAS+EPO, radiation plus standard resection plus anastomosis plus EPO. All animals were sacrificed by cardiac puncture, and anastomotic healing was measured by bursting pressure, hydroxyproline (OHP) levels, myeloperoxidase (MPO) activity and histopathological evaluations. Malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α), and matrix metalloproteinase-9 (MMP-9) were also measured in serum specimens. RESULTS OHP levels in the RT+ANAS + EPO group were significantly increased compared with other groups (p < .05). In contrast, MPO activity in the RT+ANAS+EPO group was significantly decreased compared with other groups (p < .05). Serum MDA levels were found to be decreased in the ANAS+EPO and RT+ANAS+EPO groups (p < .05). Group comparisons demonstrated that bursting pressure was significantly higher in EPO treated rats (p < .05). The histopathology results revealed that EPO treatment improves anastomotic wound healing though decreased necrosis and inflammatory cell infiltration and increased fibroblast activity. CONCLUSION The findings of the present study indicate that EPO contributes to wound healing and the strength of colon anastomosis following radiation due to its antioxidant and anti-inflammatory effects, but further studies are needed to explore the significance of these effects.
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Soybir OC, Gürdal SÖ, Oran EŞ, Tülübaş F, Yüksel M, Akyıldız Aİ, Bilir A, Soybir GR. Delayed cutaneous wound healing in aged rats compared to younger ones. Int Wound J 2011; 9:478-87. [PMID: 22128764 DOI: 10.1111/j.1742-481x.2011.00897.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Delayed wound healing in elderly males is a complex process in which the factors responsible are not fully understood. This study investigated the hormonal, oxidative and angiogenic factors affecting wound healing in aged rats. Two groups consisting of eight healthy male Wistar Albino rats [young (30 ± 7 days) and aged (360 ± 30 days)], and a cutaneous incision wound healing model were used. Scar tissue samples from wounds on the 7th, 14th and 21st days of healing were evaluated for hydroxyproline and vascular endothelial growth factor content. Macrophage, lymphocyte, fibroblast and polymorphonuclear cell infiltration; collagen formation and vascularization were assessed by light and electron microscopy. The free oxygen radical content of the wounds was measured by a chemiluminescence method. Blood sample analysis showed that the hydroxyproline and total testosterone levels were significantly higher, and the oxygen radical content was significantly lower in young rats. Histopathological, immunohistochemical and ultrastructural evaluations revealed higher amounts of fibroblasts and collagen fibers, and more vascularization in young rats. These results are indicative of the delayed wound healing in aged rats. A combination of multiple factors including hormonal regulation, free oxygen radicals and impaired angiogenesis appears to be the cause of delayed cutaneous healing.
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Comparison of bipolar electrosurgical devices with ligatures and endoclips in the rat appendicitis model. J Pediatr Surg 2011; 46:1923-9. [PMID: 22008329 DOI: 10.1016/j.jpedsurg.2011.04.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2011] [Revised: 04/29/2011] [Accepted: 04/29/2011] [Indexed: 12/23/2022]
Abstract
PURPOSE The aim of this study is to compare bipolar radiofrequency-driven vessel sealer, bipolar electrocautery, polyglactin 910 sutures, and endoclips in appendiceal stump closure with respect to operative time, appendiceal stump strength, and inflammation in a rat appendiceal model. METHODS Forty-eight Wistar-Albino rats, which had previously created appendicitis, were divided into 2 (groups A and B). Each group was further subdivided into 4 subgroups (AL, ABPC, AC, AS, BL, BBPC, BC, and BS) each containing 6 rats. An appendectomy was performed, and the stump was closed by bipolar radiofrequency-driven vessel sealer in the L, bipolar electrocautery in the BPC, endoclips in the C, and ligatures in the S subgroups. Cecum bursting pressures were determined instantly after the operation in group A and on the seventh postoperative day in group B. All operative times were measured. Appendices and appendiceal stumps underwent histopathologic examination. Statistical analyses were performed with Kruskal-Wallis and Mann-Whitney U tests. P < .05 was considered significant. RESULTS Bursting pressures of the subgroups were comparable on postoperative immediate period and day 7. Operative times were significantly shorter in the L and BPC subgroups in A and B. Histopathologic examination showed that the inflammation scores were similar in group A. In group B, inflammation parameters were also similar except the necrosis status, which was found to be decreased in BL compared with BC and BS. Necrosis status was significantly lower, and lymphocyte quantity was significantly higher in BL and BBPC compared with AL and ABPC. CONCLUSIONS Bipolar radiofrequency-driven vessel sealer and bipolar electrocautery achieve safe stump closure with satisfactory bursting pressure values in an experimental rat appendicitis model. Decreased operative time and unimpaired healing are encouraging.
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