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1
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Lundy M, Ashburn JH. Management of the Hostile Abdomen. Clin Colon Rectal Surg 2022; 35:169-176. [PMID: 35966382 PMCID: PMC9374530 DOI: 10.1055/s-0041-1740043] [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: 11/03/2022]
Abstract
Caring for a patient with a hostile abdomen is one of the most challenging clinical situations one can encounter. It requires specialized technical skill coupled with bold but thoughtful decision-making to achieve good outcomes. An approach to the patient with a complex, hostile abdomen must be individualized to account for the patient's personal details. However, implementing an experienced-based algorithm to help make the difficult decisions required in this setting can be helpful, as evidence-based studies are few. The purpose of this review is to provide a structured, evidence, and experienced-based approach to the challenges that the surgeon encounters when faced with a patient with a hostile abdomen, and to discuss perioperative and intraoperative surgical strategies that can lead to most successful outcomes.
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Affiliation(s)
- Megan Lundy
- Division of Colorectal Surgery, Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, North Carolina
| | - Jean H. Ashburn
- Division of Colorectal Surgery, Department of Surgery, Wake Forest University Baptist Health, Winston-Salem, North Carolina
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2
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Detection of Anastomotic Leakage Following Elective Colonic Surgery: Results of the Prospective Biomarkers and Anastomotic Leakage (BALL) Study. J Surg Res 2022; 273:85-92. [PMID: 35033821 DOI: 10.1016/j.jss.2021.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is an infrequent but life-threatening surgical complication following colorectal surgery. Early diagnosis remains clinically difficult but is a necessity to reduce associated morbidity and mortality. Clinical review and radiological modalities for the diagnosis of leakage remain non-specific and often only detect AL once it is well developed. Inflammatory biomarkers however have shown promise in early pre-clinical detection of leakage following colorectal surgery. METHODS A multi-center, prospective observational study was conducted across four public hospitals in Auckland and Christchurch, New Zealand. Consecutive adults undergoing elective colectomy were initially recruited over a 3-y period. Perioperative blood samples were collected to measure interleukin (IL)-6, IL-1β, tumor necrosis factor α, IL-10, C-reactive protein (CRP), leukocyte and neutrophil counts. Statistical analysis was performed to compare patients with an uncomplicated recovery with patients with AL. RESULTS Sixteen patients developed AL (5.7%), diagnosed at a median post-operative (POD) day 7. CRP and IL-6 were consistently elevated in the early post-operative period in patients with AL, and had the best diagnostic accuracy on POD 3 (area under the curve 0.70; P = 0.02) and POD 1 (area under the curve 0.69; P = 0.02), respectively. IL-10, once adjusted for body mass index and surgical approach, was the sole biomarker significantly elevated in patients with AL on POD 4. CONCLUSIONS Early post-operative elevations of CRP and IL-6 provide utility for early detection of AL after elective colectomy. Application of these inflammatory biomarkers and their combinations in daily practice warrants further investigation.
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Strowitzki MJ, Kimmer G, Wehrmann J, Ritter AS, Radhakrishnan P, Opitz VM, Tuffs C, Biller M, Kugler J, Keppler U, Harnoss JM, Klose J, Schmidt T, Blanco A, Taylor CT, Schneider M. Inhibition of HIF-prolyl hydroxylases improves healing of intestinal anastomoses. JCI Insight 2021; 6:139191. [PMID: 33784253 PMCID: PMC8119215 DOI: 10.1172/jci.insight.139191] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/24/2021] [Indexed: 12/15/2022] Open
Abstract
Anastomotic leakage (AL) accounts for a major part of in-house mortality in patients undergoing colorectal surgery. Local ischemia and abdominal sepsis are common risk factors contributing to AL and are characterized by upregulation of the hypoxia-inducible factor (HIF) pathway. The HIF pathway is critically regulated by HIF-prolyl hydroxylases (PHDs). Here, we investigated the significance of PHDs and the effects of pharmacologic PHD inhibition (PHI) during anastomotic healing. Ischemic or septic colonic anastomoses were created in mice by ligation of mesenteric vessels or lipopolysaccharide-induced abdominal sepsis, respectively. Genetic PHD deficiency (Phd1-/-, Phd2+/-, and Phd3-/-) or PHI were applied to manipulate PHD activity. Pharmacologic PHI and genetic PHD2 haplodeficiency (Phd2+/-) significantly improved healing of ischemic or septic colonic anastomoses, as indicated by increased bursting pressure and reduced AL rates. Only Phd2+/- (but not PHI or Phd1-/-) protected from sepsis-related mortality. Mechanistically, PHI and Phd2+/- induced immunomodulatory (M2) polarization of macrophages, resulting in increased collagen content and attenuated inflammation-driven immune cell recruitment. We conclude that PHI improves healing of colonic anastomoses in ischemic or septic conditions by Phd2+/--mediated M2 polarization of macrophages, conferring a favorable microenvironment for anastomotic healing. Patients with critically perfused colorectal anastomosis or abdominal sepsis could benefit from pharmacologic PHI.
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Affiliation(s)
- Moritz J Strowitzki
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany.,School of Medicine and Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Gwendolyn Kimmer
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Julian Wehrmann
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Alina S Ritter
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Praveen Radhakrishnan
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Vanessa M Opitz
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Christopher Tuffs
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Marvin Biller
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Julia Kugler
- School of Medicine and Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Ulrich Keppler
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany.,Department of Anaesthesiology, Heidelberg University, Heidelberg, Germany
| | - Jonathan M Harnoss
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Johannes Klose
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Thomas Schmidt
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Alfonso Blanco
- Flow Cytometry Core Technology. Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Cormac T Taylor
- School of Medicine and Conway Institute of Biomolecular & Biomedical Research, University College Dublin, Dublin, Ireland
| | - Martin Schneider
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
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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 2021; 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] [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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Abuabakar AI, Miner EN. Giant pedunculated incisional hernia. Ann Afr Med 2020; 19:282-285. [PMID: 33243954 PMCID: PMC8015954 DOI: 10.4103/aam.aam_56_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ventral hernia is a common complication of abdominal surgeries, with the incidence of up to 20% in some series. Giant ventral hernia is that with a neck more than 10 cm wide. The loss of abdominal domain due to the shift of viscera into the hernia sac could lead to the complication after surgery. A 54-year-old female presented with a giant pedunculated ventral hernia. She had low tension mesh repair through a transverse suprapubic incision. The surgical repair of giant hernia with mesh has led to reduced complications. The sublay mesh repair method has further reduced the rate of underlay mesh recurrence.
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Affiliation(s)
- Amina I Abuabakar
- Department of Surgery, College of Health Sciences, University of Abuja, Abuja, Nigeria
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Wong JB, Henninger DD, Clymer JW, Ricketts CD, Fryrear RS. A Novel, Easy-to-Use Staple Line Reinforcement for Surgical Staplers. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2020; 13:23-29. [PMID: 32099487 PMCID: PMC6996221 DOI: 10.2147/mder.s234156] [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: 10/10/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
Background Staple line reinforcement (SLR) is a popular tool used by surgeons to increase staple line strength and improve peri-operative hemostasis. However, currently marketed buttress materials require special attention in attachment to the staple anvil and cartridge and may come loose during typical maneuvering of stapling procedures. We have evaluated a new SLR that has an attachment material that affixes buttress across the entire anvil and cartridge face to prevent slipping, twisting, sliding and/or bunching. Methods In benchtop and preclinical testing, the new buttress material (ECHELON ENDOPATH™ Staple Line Reinforcement) was compared to a commercially available SLR for physical characteristics, including strength, absorption, security on the anvil and cartridge during stapler manipulation, impact on the tissue healing response and tissue abrasion. The two SLR’s were also compared to a staple line without buttress for hemostasis. Results The new SLR was 180% stronger initially and maintained a greater strength for up to 14 days of exposure to an in vitro solution (p≤0.001), even though it was lighter and exhibited a faster rate of degradation. The new buttress material maintained complete adherence to the anvil and cartridge throughout tissue manipulation, whereas the commercial product lost substantial coverage in 72% of samples. Both SLR’s provided superior hemostasis to the non-buttress control, with minimal impact on tissue healing or abrasion. Conclusion Because the new buttress material comes with attachment material affixed across the entire anvil and cartridge face of the stapler and maintains coverage during manipulations, it should be much easier to use. The physical characteristics of the new SLR were as good as or better than current product that requires the buttress to be applied to the cartridge and anvil. In addition, the new SLR is similar in hemostasis to standard products and superior to stapling without the use of buttress. Further research is needed to determine whether these preclinical benefits carry over into a clinical setting.
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Fink O, Buysse A, Drobatz KJ, Bentley A. Identification of risk factors for recurrent secondary septic peritonitis following initial surgical treatment of secondary septic peritonitis in dogs. J Vet Emerg Crit Care (San Antonio) 2020; 30:213-220. [PMID: 32096303 DOI: 10.1111/vec.12939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 08/02/2018] [Accepted: 10/31/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To report the incidence of and risk factors for development of recurrent secondary septic peritonitis (RSSP) in dogs. To report the outcome of dogs treated surgically for RSSP. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS One hundred forty-nine client-owned dogs treated surgically for secondary septic peritonitis (SSP). INTERVENTIONS None. MEASUREMENTS AND RESULTS The medical records database was searched for dogs that underwent surgery to treat SSP. Of 149 dogs that met the inclusion criteria, 15 (10.1%) dogs developed RSSP following surgery and 134 (89.9%) did not. Dogs with RSSP had significantly lower albumin prior to the first surgery to treat secondary septic peritonitis (SPsx1) (median 18 g/L [1.8 g/dL] vs 22 g/L [2.2 g/dL], P = 0.005) and significantly higher PCV prior to SPsx1 (median 52% vs 45%, P = 0.028). Dogs with septic peritonitis of gastrointestinal (GI) origin were significantly more likely to develop recurrent peritonitis than those with sepsis from a non-GI source (odds ratio [OR], 4.4, 95% CI: 0.95-20, P = 0.041). Of dogs with sepsis of GI origin, those with sepsis due to a foreign body were significantly more likely to develop RSSP than those with GI sepsis from a non-foreign body cause (OR, 7.2, 95% CI: 1.6-43, P = 0.0018). Of the 15 dogs in the RSSP group, 8 were euthanized without further treatment. Relaparotomy was performed in the remaining 7 cases; 3 of these (42.9%) survived. CONCLUSIONS There was a 10.1% rate of RSSP following SPsx1. Preoperative albumin was significantly lower and preoperative PCV was significantly higher in dogs that developed recurrence. Dogs with GI sepsis were at increased risk of recurrence and, among dogs with GI sepsis, the presence of a foreign body was an additional risk factor for recurrence.
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Affiliation(s)
- Owen Fink
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Allison Buysse
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Kenneth J Drobatz
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Adrienne Bentley
- Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA
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8
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Ghiselli R, Lucarini G, Ortenzi M, Salvolini E, Saccomanno S, Orlando F, Provinciali M, Casciani F, Guerrieri M. Anastomotic healing in a rat model of peritonitis after non-steroidal anti-inflammatory drug administration. Eur J Histochem 2020; 64. [PMID: 31941266 PMCID: PMC6985910 DOI: 10.4081/ejh.2020.3085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/27/2019] [Indexed: 01/01/2023] Open
Abstract
The tissue inflammatory response can influence the outcome of anastomotic healing. Anastomotic leakage represents a dreadful complication after gastrointestinal surgery, in particular sepsis and intra-abdominal infections impair the restorative process of colic anastomoses. It has been debated whether the administration of nonsteroidal anti-inflammatory drugs (NSAIDs) is a risk factor for dehiscence, since many patients receive NSAIDs in the early postoperative period. Our aim was, for the first time, to analyze the morpho-functional effects of postoperative administration of two commonly used NSAIDs, Diclofenac and Ketorolac, on the healing process of colo-colic anastomoses constructed under condition of fecal peritonitis in a rat model. Sixty adult male rats underwent two surgical procedures: peritonitis induction and colo-colic anastomosis, and were divided into three groups: 20 rats received saline; 20 rats 4 mg/kg Diclofenac and 20 rats 5 mg/kg Ketorolac. We assessed anastomosis strength, morphological features of tissue wound healing, immunohistochemical metalloproteinase 9 (MMP9) expression and collagen deposition and content by Sirius red staining and hydroxyproline level. We found no significant difference in bursting pressure, collagen content and organization and morphological features between the groups, except a significantly reduced presence of inflammatory cells and MMP9 expression in the groups treated with NSAIDs. Our findings showed that Diclofenac and Ketorolac administration did not affect post-surgical healing and did not increase the leakage risk of colo-colic anastomoses during peritonitis.
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9
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Wiegering A, Liebetrau D, Menzel S, Bühler C, Kellersmann R, Dietz UA. The incidence of incisional hernia after aortic aneurysm is not higher than after benign colorectal interventions: A retrospective control-matched cohort study. GEFASSCHIRURGIE 2018; 23:23-31. [PMID: 29950793 PMCID: PMC5997103 DOI: 10.1007/s00772-018-0390-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Abdominal aortic aneurysms (AAA) have most probably an inflammatory origin, whereby the elastica is the layer actually involved. In the past, collagen weackness was supposed to be the shared cause of both, AAA and incisional hernias. Since the development of new techniques of closure of the abdominal wall over the last decade, collagen deficency seems to play only a secondary etiologic role. Objectives The aim of the study was to investigate whether the incidence of incisional hernia following laparotomy due to AAA differs from that of colorectal interventions. Material and methods This was a retrospective control matched cohort study. After screening of 403 patients with colorectal interventions and 96 patients with AAA, 27 and 72 patients, respectively were included. The match criteria for inclusion of patients with colorectal interventions were: age, benign underlying disease and median xiphopubic laparotomy. The primary endpoint was the incidence of an incisional hernia. The secondary endpoints were the risk profile, length of stay in the intensive care unit and postoperative complications. Data analysis was carried in the consecutive collective from 2006 to 2008. Results In the group with AAA the mean follow-up was 34.5±18.1 months and in the group with colorectal interventions 35.7±21.4 months. The incidence of incisional hernias showed no significant differences between the two groups. In the AAA group 10 patients (13.8%) developed an incisional hernia in contrast to 7 patients in the colorectal intervention group (25.9%). Conclusions In our collective patients with AAA did not show an increased incidence of incisional hernia in comparison to patients with colorectal interventions with comparable size of the laparotomy access and age. The quality of closure of the abdominal wall seems to be an important factor for the prevention of incisional hernia.
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Affiliation(s)
- A Wiegering
- 1Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany.,2Lehrstuhl für Biochemie und Molekularbiologie, Universität Würzburg, Würzburg, Germany
| | - D Liebetrau
- 1Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - S Menzel
- 1Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - C Bühler
- 1Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - R Kellersmann
- 1Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - U A Dietz
- 1Klinik und Poliklinik für Allgemein‑, Viszeral‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Germany.,3Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baselstr. 150, 4600 Olten, Switzerland
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Roles of Macrophage Subtypes in Bowel Anastomotic Healing and Anastomotic Leakage. J Immunol Res 2018; 2018:6827237. [PMID: 29670921 PMCID: PMC5835259 DOI: 10.1155/2018/6827237] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/21/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022] Open
Abstract
Macrophages play an important role in host defense, in addition to the powerful ability to phagocytose pathogens or foreign matters. They fulfill a variety of roles in immune regulation, wound healing, and tissue homeostasis preservation. Macrophages are characterized by high heterogeneity, which can polarize into at least two major extremes, M1-type macrophages (classical activation) which are normally derived from monocytes and M2-type macrophages (alternative activation) which are mostly those tissue-resident macrophages. Based on the wound healing process in skin, the previous studies have documented how these different subtypes of macrophages participate in tissue repair and remodeling, while the mechanism of macrophages in bowel anastomotic healing has not yet been established. This review summarizes the currently available evidence regarding the different roles of polarized macrophages in the physiological course of anastomotic healing and their pathological roles in anastomotic leakage, the most dangerous complication after gastrointestinal surgery.
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Davis DJ, Demianiuk RM, Musser J, Podsiedlik M, Hauptman J. Influence of preoperative septic peritonitis and anastomotic technique on the dehiscence of enterectomy sites in dogs: A retrospective review of 210 anastomoses. Vet Surg 2017; 47:125-129. [DOI: 10.1111/vsu.12704] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/10/2017] [Accepted: 04/30/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Daniel J. Davis
- Department of Small Animal Clinical Sciences; Michigan State University; East Lansing Michigan
| | - Ryan M. Demianiuk
- Department of Small Animal Clinical Sciences; Michigan State University; East Lansing Michigan
| | - Jon Musser
- Department of Small Animal Clinical Sciences; Michigan State University; East Lansing Michigan
| | - Maria Podsiedlik
- Department of Small Animal Clinical Sciences; Michigan State University; East Lansing Michigan
| | - Joe Hauptman
- Department of Small Animal Clinical Sciences; Michigan State University; East Lansing Michigan
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Vallance A, Wexner S, Berho M, Cahill R, Coleman M, Haboubi N, Heald RJ, Kennedy RH, Moran B, Mortensen N, Motson RW, Novell R, O'Connell PR, Ris F, Rockall T, Senapati A, Windsor A, Jayne DG. A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery. Colorectal Dis 2017; 19:O1-O12. [PMID: 27671222 DOI: 10.1111/codi.13534] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/27/2016] [Indexed: 02/06/2023]
Abstract
The reduction of the incidence, detection and treatment of anastomotic leakage (AL) continues to challenge the colorectal surgical community. AL is not consistently defined and reported in clinical studies, its occurrence is variably reported and its impact on longterm morbidity and health-care resources has received relatively little attention. Controversy continues regarding the best strategies to reduce the risk. Diagnostic tests lack sensitivity and specificity, resulting in delayed diagnosis and increased morbidity. Intra-operative fluorescence angiography has recently been introduced as a means of real-time assessment of anastomotic perfusion and preliminary evidence suggests that it may reduce the rate of AL. In addition, concepts are emerging about the role of the rectal mucosal microbiome in AL and the possible role of new prophylactic therapies. In January 2016 a meeting of expert colorectal surgeons and pathologists was held in London, UK, to identify the ongoing controversies surrounding AL in colorectal surgery. The outcome of the meeting is presented in the form of research challenges that need to be addressed.
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Affiliation(s)
- A Vallance
- Royal College of Surgeons of England, London, UK
| | - S Wexner
- Cleveland Clinic Florida, Weston, Florida, USA
| | - M Berho
- Cleveland Clinic Florida, Weston, Florida, USA
| | - R Cahill
- University College Dublin, Dublin, Ireland
| | | | - N Haboubi
- University Hospital of South Manchester, Manchester, UK
| | - R J Heald
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - B Moran
- Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | - R W Motson
- The ICENI Centre, Colchester University Hospital, Colchester, UK
| | - R Novell
- The Royal Free Hospital, London, UK
| | | | - F Ris
- Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - T Rockall
- Royal Surrey County Hospital, Guildford, UK
| | | | - A Windsor
- University College Hospital, London, UK
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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; 17:84-9. [PMID: 27426959 DOI: 10.1016/j.ajg.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [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]
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Nerstrøm M, Krarup PM, Jorgensen LN, Ågren MS. Therapeutic improvement of colonic anastomotic healing under complicated conditions: A systematic review. World J Gastrointest Surg 2016; 8:389-401. [PMID: 27231518 PMCID: PMC4872068 DOI: 10.4240/wjgs.v8.i5.389] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 11/14/2015] [Accepted: 03/09/2016] [Indexed: 02/07/2023] Open
Abstract
AIM: To identify therapeutic agents for the prophylaxis of gastrointestinal anastomotic leakage (AL) under complicated conditions.
METHODS: The PubMed and EMBASE databases were searched for English articles published between January 1975 and September 2014. Studies with the primary purpose of improving anastomotic healing in the colon or rectum under complicated preoperative and/or intraoperative conditions were included. We excluded studies investigating the adverse effects or risk assessment of an active intervention. Furthermore, investigations of biophysical materials, sealants, electrical stimulation and nutrients were excluded. The primary study outcome was biomechanical anastomotic strength or AL. The meta-analysis focused on therapeutic agents that were investigated in one animal model using the same outcome by at least three independent research groups.
RESULTS: The 65 studies included were divided into 7 different complicated animal models: Bowel ischemia, ischemia/reperfusion, bowel obstruction, obstructive jaundice, peritonitis, chemotherapy and radiotherapy. In total, 48 different therapeutic compounds were examined. The majority of investigated agents (65%) were reported as beneficial for anastomotic healing. Twelve of the agents (25%) were tested more than once in the same model, whereas 13 (27%) of the agents were tested in two or more models of complicated healing. Two therapeutic agents met our inclusion criteria for the meta-analysis. Postoperative hyperbaric oxygen therapy significantly increased anastomotic bursting pressure in ischemic colon anastomoses by a mean of 28 mmHg (95%CI: 17 to 39 mmHg, P < 0.00001). Granulocyte macrophage-colony stimulating factor failed to show a significant increase in anastomotic bursting pressure (95%CI: -20 to 21 mmHg, P = 0.97) vs controls in experimental chemotherapeutic models.
CONCLUSION: This systematic review identified potential therapeutic agents, but more studies are needed before concluding that any of these are useful for AL prophylaxis.
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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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Snowdon KA, Smeak DD, Chiang S. Risk Factors for Dehiscence of Stapled Functional End-to-End Intestinal Anastomoses in Dogs: 53 Cases (2001-2012). Vet Surg 2015; 45:91-9. [PMID: 26565990 DOI: 10.1111/vsu.12413] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify risk factors for dehiscence in stapled functional end-to-end anastomoses (SFEEA) in dogs. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n = 53) requiring an enterectomy. METHODS Medical records from a single institution for all dogs undergoing an enterectomy (2001-2012) were reviewed. Surgeries were included when gastrointestinal (GIA) and thoracoabdominal (TA) stapling equipment was used to create a functional end-to-end anastomosis between segments of small intestine or small and large intestine in dogs. Information regarding preoperative, surgical, and postoperative factors was recorded. RESULTS Anastomotic dehiscence was noted in 6 of 53 cases (11%), with a mortality rate of 83%. The only preoperative factor significantly associated with dehiscence was the presence of inflammatory bowel disease (IBD). Surgical factors significantly associated with dehiscence included the presence, duration, and number of intraoperative hypotensive periods, and location of anastomosis, with greater odds of dehiscence in anastomoses involving the large intestine. CONCLUSION IBD, location of anastomosis, and intraoperative hypotension are risk factors for intestinal anastomotic dehiscence after SFEEA in dogs. Previously suggested risk factors (low serum albumin concentration, preoperative septic peritonitis, and intestinal foreign body) were not confirmed in this study.
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Affiliation(s)
- Kyle A Snowdon
- College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Daniel D Smeak
- College of Veterinary Medicine, Colorado State University, Fort Collins, Colorado
| | - Sharon Chiang
- Department of Statistics, Rice University, Houston, Texas
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The prevention of colorectal anastomotic leakage with tissue adhesives in a contaminated environment is associated with the presence of anti-inflammatory macrophages. Int J Colorectal Dis 2014; 29:1507-16. [PMID: 25255850 DOI: 10.1007/s00384-014-2012-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Colorectal anastomoses created in a contaminated environment result in a high leakage rate. This study investigated whether using anastomotic sealants (TissuCol(®), Histoacryl(®) Flex, and Duraseal(®)) prevents leakage in a rat peritonitis model. STUDY DESIGN Sixty-seven Wistar rats were divided into control and experimental groups (TissuCol, Histoacryl, and Duraseal groups). Peritonitis was induced 1 day before surgery with the cecal ligation puncture model. On day 0, colonic anastomosis was constructed with sutures and then sealed with no adhesive (control group) or one select adhesive (experimental groups). Bursting pressure, abscess formation, and adhesion severity were evaluated on day 3 or day 14. Hematoxylin and eosin staining and immunohistochemical staining for CD4, CD8, CD206, and iNOS were performed. RESULTS On day 3, bursting pressures of the TissuCol group (120.1 ± 25.3 mmHg), Histoacryl group (117.3 ± 20.2 mmHg), and Duraseal group (123.6 ± 35.4 mmHg) were significantly higher than the that of the control group (24.4 ± 31.7 mmHg, p < 0.001). Abscesses around the anastomosis were found in the control group (6/7) and Duraseal group (2/9) but not in the TissuCol group or Histoacryl group. A higher number of CD206+ cells (M2 macrophages), a lower number of iNOS+ cells (M1 macrophages), a higher M2/M1 index, and a higher CD4+/CD8+ index were seen at the anastomotic site in all experimental groups compared with the control group on day 3. On day 14, abscesses were only found in the control group. Adhesion severity in the Duraseal group was significantly lower than that in the control group (p = 0.001). CONCLUSIONS Anastomotic sealing using TissuCol(®), Histoacryl(®) Flex, or Duraseal(®) seems to be an effective and safe option to prevent leakage in contaminated colorectal surgery. The presence of large numbers of anti-inflammatory macrophages seems to be involved in preventing the leakage.
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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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Anastomotic stability and wound healing of colorectal anastomoses sealed and sutured with a collagen fleece in a rat peritonitis model. Asian J Surg 2013; 37:35-45. [PMID: 23978425 DOI: 10.1016/j.asjsur.2013.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 06/20/2013] [Accepted: 07/09/2013] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND/OBJECTIVE Anastomotic insufficiency is associated with increased morbidity and mortality. A collagen fleece that supports anastomosis is effective for preventing anastomosis insufficiency. The objective of this study was to compare between the stability of sutured anastomoses and that of anastomoses sealed with a thrombin/fibrinogen-coated collagen fleece in a rat peritonitis model. METHODS In 72 male Wistar rats, peritonitis was induced with a specially prepared human fecal solution. Surgery at the rectosigmoid junction was performed 24-36 hours later. The different anastomotic techniques used were circular sutured anastomoses, semicircular sutured anastomosis and closure of the anterior wall with collagen patch, and complete closure with a collagen fleece. Bursting pressure, histology of anastomosis, mRNA expression of collagen types I and III, matrix metalloproteinase-13, and vascular endothelial growth factor (VEGF) were investigated after 24 hours, 72 hours, and 120 hours. RESULTS All animals developed peritonitis of comparable severity. There were no differences in bursting pressures between the three suture techniques after 24 hours, 72 hours, or 120 hours. Anastomoses sealed with a collagen fleece appeared to be slightly less stable only at 24 hours, whereas they appeared to be more stable than semisutured or fully sutured anastomoses at 72 hours and 120 hours. Sealing with a collagen fleece was associated with an increase in granulation tissue, higher mRNA levels for collagen types I and III, and higher VEGF compared to sutured anastomoses. CONCLUSION The use of a thrombin/fibrinogen-coated collagen fleece showed similar efficacy to conventional sutures in colorectal anastomoses in the presence of peritonitis inflammation, and may provide additional benefits due to an increase in mature granulation tissue.
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Farias Rolim M, Riger CJ, Eleutherio EC, da Fonseca Colão C, Cotta Pereira G, Schanaider A. Colonic healing after portal ischemia and reperfusion: an experimental study with oxidative stress biomarkers. Redox Rep 2013; 12:267-74. [DOI: 10.1179/135100007x239261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Grimes J, Schmiedt C, Milovancev M, Radlinsky M, Cornell K. Efficacy of Serosal Patching in Dogs with Septic Peritonitis. J Am Anim Hosp Assoc 2013; 49:246-9. [DOI: 10.5326/jaaha-ms-5870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to evaluate the correlation of serosal patching in dogs with existing septic peritonitis with continued postoperative septic peritonitis and death. Records were collected from dogs that underwent intestinal surgery from 1998 to 2007 at four veterinary teaching hospitals and one private referral clinic. Dogs were included if they were diagnosed with septic peritonitis and had subsequent surgery of either the small intestine or cecum. Eighty-two surgeries were evaluated. Eighteen dogs (22%) received a serosal patch during surgery. Of those, three dogs (16.7%) had septic peritonitis postoperatively. Sixty-four dogs (78%) did not receive a serosal patch, and 19 of those dogs (29.7%) had postoperative septic peritonitis (P = 0.27). Of the 18 cases with serosal patching, 6 (33.3%) died prior to discharge. Of the 63 cases that did not receive a patch and had information regarding survival, 14 (22.2%) died prior to discharge (P = 0.34). Use of a serosal patch did not protect dogs from either postoperative septic peritonitis or failure to survive.
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Affiliation(s)
- Janet Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.G., C.S., M.R., K.C.); and Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR (M.M.)
| | - Chad Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.G., C.S., M.R., K.C.); and Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR (M.M.)
| | - Milan Milovancev
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.G., C.S., M.R., K.C.); and Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR (M.M.)
| | - MaryAnn Radlinsky
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.G., C.S., M.R., K.C.); and Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR (M.M.)
| | - Karen Cornell
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA (J.G., C.S., M.R., K.C.); and Department of Clinical Sciences, College of Veterinary Medicine, Oregon State University, Corvallis, OR (M.M.)
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Celik A, Ergun E, Koksal N, Celik AS, Altinli E, Uzun MA, Eroglu E, Kemik A. Effects of montelukast on the healing of ischemic colon anastomoses. Am J Surg 2013; 206:502-8. [PMID: 23809995 DOI: 10.1016/j.amjsurg.2013.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 02/03/2013] [Accepted: 03/21/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this study was to examine whether treatment with montelukast, a selective leukotriene antagonist, would affect anastomotic healing in a reperfused colon rat model with remote ischemia/reperfusion injury. METHODS Rats (n = 12 per group) were intraperitoneally administered normal saline or 10 mg/kg montelukast sodium 60 minutes before and for 5 days after surgery. Ischemia was induced for 45 minutes through superior mesenteric artery occlusion. A left colon anastomosis was made. Blood and perianastomotic tissue samples were obtained on postoperative day 5. RESULTS Mean anastomotic bursting pressures of the control and montelukast groups were 159.17 ± 29.99 and 216.67 ± 26.40, respectively (P < .001). Compared with saline, montelukast treatment increased the mean tissue hydroxyproline level (2.46 ± .30 vs 3.61 ± .33 μmol/L) and decreased tissue caspase-3 activity (36.06 ± 5.72 vs 21.78 ± 3.87) and malondialdehyde levels (3.43 ± .34 vs 2.29 ± .34 nmol/g) (P < .001 for all). Other plasma markers of injury also showed differences. CONCLUSIONS Montelukast prevented ischemia/reperfusion-induced damage in a rat model of colonic anastomotic wound healing.
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Affiliation(s)
- Atilla Celik
- Department of General Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey.
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Marques e Silva S, Oliveira MVMD, Brandão AM, Carneiro FP, Ferreira VMM, Parra RS, Feres O, Sousa JB. Study on adhesion formation and the healing of colon anastomosis in rats with induced peritoneal sepsis. Acta Cir Bras 2012; 26 Suppl 2:100-5. [PMID: 22030823 DOI: 10.1590/s0102-86502011000800018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the effects of abdominal sepsis on adhesion formation and colon anastomosis healing in rats. METHODS Forty rats were distributed in two groups containing 20 rats each for left colon anastomosis in the presence (Group S) or absence (Group N) of induced sepsis by cecal ligation and puncture. Each group was divided into subgroups for euthanasia on the third (N3 and S3) or seventh (N7 or S7) post-operative day. The amount of adhesions was evaluated and a segment of the colon was removed for histopathologic analysis, bursting strength assessment, hydroxyproline and the determination of tissue collagen. RESULTS The subjects which underwent cecal ligation and puncture presented a higher amount of intra-abdominal adherences in both third (p=0,00) and seventh (p=0,00) post-operatory days. Smaller bursting strengths were found in the S3 subgroup, and greater bursting strengths were found in the S7 subgroup. There was no difference in the variations on the concentrations of hydroxyproline, tissue collagen and histopathology. CONCLUSIONS The peritoneal infection which was developed by cecal ligation and puncture raised the amount of intra-cavitary adhesions. There was a decrease in the amount of colonic anastomosis on the third post-operatory day with a following raise on the seventh without any effects on other healing parameters.
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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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Rocha AA, Leal RF, Ayrizono MDLS, Chung WF, Coy CSR, Lee HD, Fagundes JJ. Hyperbaric oxygen therapy and mechanical resistence of the colonics anastomosis in rats with peritonitis. Acta Cir Bras 2011; 25:368-74. [PMID: 20676497 DOI: 10.1590/s0102-86502010000400013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Accepted: 04/14/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To analyze the effects of hyperbaric oxygen therapy (HBO) on the mechanical resistance of anastomosis performed in rats' distal colon presenting peritonitis induced by ligature and cecal punction using the Total Energy Rupture biomechanical test (ETR). METHODS It was used 45 rats divided into three groups of 15 animals each. In Control Group (CG), it was performed anastomosis in distal colon without peritonitis. In Peritonitis Group (PG), it was performed anastomosis six hours after the induction of peritonitis by ligature and cecal punction. In Hyperbaric Chamber Group (HCG), it was performed six hours after the induction of peritonitis by ligature and cecal punction. The animals on CG and PG were kept at place air while the animals on HCG were placed on an experimental hyperbaric chamber in order to inhale oxygen at 100%, two absolute atmospheres, for 120 minutes, for four consecutive days. Euthanasia took place on the fifth day of the experiment. All the animals underwent to Total Energy Rupture Biomechanical Resistance test (ETR). Total Energy Rupture was defined as the necessary internal energy stored up to promote the colon rupture after an external traction force imposition. RESULTS The Peritonitis Group presents smaller average ETR than Control Group. There was no statistical difference between Peritonitis Group and Hyberbaric Chamber Group. CONCLUSION Hyperbaric oxygen therapy did not alter the mechanical resistance of anastomosis performed in distal colon of rats under the presence of peritonitis induced by ligature and cecal puncture.
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Affiliation(s)
- Antonio Angelo Rocha
- Post-graduate Program in Surgery, University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Holzner PA, Kulemann B, Kuesters S, Timme S, Hoeppner J, Hopt UT, Marjanovic G. Impact of remote ischemic preconditioning on wound healing in small bowel anastomoses. World J Gastroenterol 2011; 17:1308-16. [PMID: 21455330 PMCID: PMC3068266 DOI: 10.3748/wjg.v17.i10.1308] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 11/17/2010] [Accepted: 11/24/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the influence of remote ischemic preconditioning (RIPC) on anastomotic integrity.
METHODS: Sixty male Wistar rats were randomized to six groups. The control group (n = 10) had an end-to-end ileal anastomosis without RIPC. The preconditioned groups (n = 34) varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis (n = 9). On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosal ischemic injury were collected. The data are given as median (range).
RESULTS: On postoperative day 4, median bursting pressure was 124 mmHg (60-146 mmHg) in the control group. The experimental groups did not show a statistically significant difference (P > 0.05). Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group.
CONCLUSION: RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning.
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Grimes JA, Schmiedt CW, Cornell KK, Radlinksy MAG. Identification of risk factors for septic peritonitis and failure to survive following gastrointestinal surgery in dogs. J Am Vet Med Assoc 2011; 238:486-94. [DOI: 10.2460/javma.238.4.486] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Munireddy S, Kavalukas SL, Barbul A. Intra-abdominal healing: gastrointestinal tract and adhesions. Surg Clin North Am 2010; 90:1227-36. [PMID: 21074038 DOI: 10.1016/j.suc.2010.08.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The abdominal cavity represents one of the most active areas of surgical activity. Surgical procedures involving the gastrointestinal (GI) tract are among the most common procedures performed today. Healing of the GI tract after removal of a segment of bowel and healing of the peritoneal surfaces with subsequent adhesion formation remain vexing clinical problems. Interventions to modify both the responses are myriad, yet a full understanding of the pathophysiology of these responses remains elusive. Different aspects of GI and peritoneal healing, with associated factors, are discussed in this article.
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Affiliation(s)
- Sanjay Munireddy
- Department of Surgery, Sinai Hospital of Baltimore, and the Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Bicalho PRR, Mayrink CAC, Fernandes F, Alvarenga DG, Araujo ID, Nunes TA, Reis FA. Treatment with chlorhexidine modifies the healing of colon anastomosis in rats. J INVEST SURG 2010; 24:8-12. [PMID: 20964617 DOI: 10.3109/08941939.2010.519595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate the effects of chlorhexidine on the healing of colon anastomosis in the presence of peritonitis. METHODS Peritonitis was induced in male Wistar rats by cecal ligation and puncture (CLP). The abdominal cavities of experimental animals were irrigated with warm solutions containing 0.9% saline (SAL group; n = 8) or 0.05% chlorhexidine (CHD group; n = 8), following which colon anastomosis was performed. Rats of the control group (n = 8) were submitted to colon anastomosis but not to CLP. Animals were euthanized seven days after surgery, and healing was assessed by histopathological examination and by measuring anastomotic burst pressure. RESULTS Post-operative survival rates were 100, 87.5 and 75% for the control, SAL, and CHD groups, respectively. The degree of inflammation was significantly lower (ρ = 0.01) in the CHD group compared with the other groups, whilst the anastomotic burst pressure within the CHD group (156.7 ± 53.2 mmHg) was lower than, but not significantly different from, those of the control and SAL groups (196.3 ± 49.8, 208.6 ± 72.7 mmHg, respectively). CONCLUSIONS Peritoneal irrigation with chlorhexidine solution is effective in the control of inflammation promoted by peritonitis but does not improve healing of colon anastomosis in rats.
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Effect of the combination of fibrin glue and growth hormone on intestinal anastomoses in a pig model of traumatic shock associated with peritonitis. World J Surg 2010; 33:567-76. [PMID: 19132439 DOI: 10.1007/s00268-008-9889-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Intra-abdominal sepsis and hemorrhagic shock have been found to impair the healing of intestinal anastomoses. The present study examined whether fibrin glue (FG) and recombinant human growth hormone (GH) can improve intestinal primary anastomotic healing in a pig model of traumatic shock associated with peritonitis. Further, the study was designed to investigate the probable mechanism of these agents. METHODS Female anesthetized pigs were divided into five groups. Group sham (n = 7), pigs without traumatic shock had small bowel resection anastomoses; group control (n = 14), pigs had bowel resection anastomoses 24 h after abdominal gunshot plus exsanguination/resuscitation; group FG (n = 14); group GH (n = 14); group FG/GH (n = 14), pigs received FG, recombinant GH, or both, respectively. Recombinant GH was given daily for 7 days. Blood samples were collected daily for measurement of interleukin-6 (IL-6) and tumor necrosis factor (TNF)-alpha levels. Investigations also included adhesion formation, anastomotic bursting pressure, tensile strength, hydroxyproline (HP) content, myeloperoxidase (MPO), tumor necrosis factor (NF)-kappaB activity, and histology analysis 10 days later. A second experiment (n = 20 subjects assigned to each of the five groups) was designed to study survival during the first 20 postoperative days. RESULTS Traumatic shock associated with peritonitis led to significant decreases in intestinal anastomotic bursting pressures, tensile strengths, and tissue hydroxyproline content, along with severe adhesion formation, increases in MPO activity and NF-kappaB activity, and plasma levels of tumor necrosis factor alpha (TNF-alpha) and interleukin-6 (IL-6). Both FG and recombinant GH treatment led to early significant increases in plasma levels of TNF-alpha and IL-6. At the same time, FG alone, unlike recombinant GH alone, led to significant increases in anastomotic bursting pressures, tensile strength, and tissue HP content, along with decreases in anastomotic MPO and NF-kappaB activity and later plasma levels of TNF-a and IL-6. The FG group also developed more marked neoangiogenesis and collagen deposition on histology analysis. However, FG and recombinant GH synergistically effected improved anastomotic healing, abolishing the infaust effects promoted by recombinant GH. Adhesion formation after intestinal anastomosis could not be lowered by FG alone or by the combination of FG and recombinant GH. Both FG alone and FG/GH, in contrast to GH alone and control treatment, significantly prolonged the survival time of experimental animals. CONCLUSIONS We found that FG, but not recombinant GH, could lower the risk of anastomotic leakage, improve intestinal anastomotic healing, and prolong survival in a pig model of traumatic shock associated with peritonitis. Both FG and recombinant GH synergistically effected improved intestinal anastomotic healing. It was suggested that GH could be used locally to promote intestinal anastomotic healing in intra-abdominal peritonitis.
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Wang P, Gong G, Li Y, Li J. Hydroxyethyl starch 130/0.4 augments healing of colonic anastomosis in a rat model of peritonitis. Am J Surg 2009; 199:232-9. [PMID: 19897171 DOI: 10.1016/j.amjsurg.2009.01.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 01/14/2009] [Accepted: 01/16/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study was designed to investigate the role of hydroxyethyl starch (HES) 130/0.4 on the wound healing process in left colonic anastomoses in the presence of intra-abdominal sepsis. METHODS The left colonic anastomosis was performed in 40 rats that were divided into 4 groups: (1) group SHAM, laparatomy plus cecal mobilization (n = 10); (2) group SHAM + HES, HES130/.4-treated controls (n = 10); and (3) group CLP, cecal ligation and puncture (n = 10); (4) group CLP + HES, CLP plus HES130/.4 (n = 10). HES130/.4 was administrated before the construction of colonic anastomosis, 15 mL/kg/24 hours and daily for 4 postoperative days. Anastomotic bursting pressures (ABPs) were measured in vivo on day 5. Tissue samples were obtained for analyses of hydroxyproline (HP) contents, myeloperoxidase (MPO) activity, malondialdehyde (MDA), reduced glutathione (GSH) levels, and nuclear factor-kappaB (NF-kappaB) activation. The plasma levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, d-dimer, and protein C (PC) were also measured. Anastomotic granulation tissues were fixed for transmission electron microscopic (TEM) analyses. RESULTS Intra-abdominal sepsis led to significant decreases in colonic anastomotic bursting pressures, perianastomotic tissue HP contents, GSH levels, and plasma levels of PC, along with increases in perianastomotic tissue MPO activity, MDA levels, NF-kappaB activation, and plasma levels of TNF-alpha, IL-6, and d-dimer. However, HES130/.4 treatment significantly inhibited all these responses. TEM analyses revealed that there was a trend toward a higher density of fibroblast distribution and a higher rate of fibroblast activation in the SHAM- and HES 130/0.4-treated animals, compared with the CLP group. CONCLUSIONS This study showed that moderate doses (15 mL/kg) of HES 130/0.4 administration significantly prevented this intraperitoneal sepsis-induced impaired anastomotic healing of the left colon. This beneficial effect of HES 130/0.4 can be mainly attributed to its anti-inflammatory and antioxidant properties and beneficial effects of modulating endothelial-associated coagulopathy.
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Affiliation(s)
- Pengfei Wang
- Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 E. Zhongshan Rd., Nanjing, 210,002, China
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Uludag M, Citgez B, Ozkaya O, Yetkin G, Ozcan O, Polat N, Isgor A. Effects of amniotic membrane on the healing of primary colonic anastomoses in the cecal ligation and puncture model of secondary peritonitis in rats. Int J Colorectal Dis 2009; 24:559-67. [PMID: 19172282 DOI: 10.1007/s00384-009-0645-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2009] [Indexed: 02/07/2023]
Abstract
PURPOSE We aimed to investigate the effects of amniotic membrane on primary colonic anastomoses in a rat peritonitis model. MATERIALS AND METHODS Fifty female Sprague Dawley rats were used in the study. Bacterial peritonitis was induced in all rats by performing a cecal ligation and puncture. Ten rats served as controls for the bursting pressure measurement, while the other 40 animals were divided into two groups (the anastomosis group (P) or the amniotic membrane group (PA)), and all of them underwent colonic anastomosis. The latter group had amniotic membrane covering their anastomoses. Half of the PA and P groups were sacrificed on the third postoperative day (PA3, P3), and the other half on the seventh postoperative day (PA7, P7). RESULTS The bursting pressures were significantly higher in groups PA3 and PA7 compared with P3 (p < 0.01) and P7 (p < 0.05), respectively. Inflammatory cell infiltration and adhesion scores were significantly lower in groups PA3 and PA7 compared with groups P3 (p < 0.001, p < 0.01, respectively) and P7 (p < 0.001, p < 0.05, respectively). Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline concentrations were significantly higher in groups with amniotic membrane than in groups without amniotic membrane (p < 0.05, for all comparisons). CONCLUSION This study showed that the covering of colonic anastomoses with amniotic membrane significantly prevented the delaying effect of intraperitoneal sepsis and provided a safer and stronger anastomosis than suture and that this was the case for both the early and late phases of anastomotic healing in the colon.
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Affiliation(s)
- Mehmet Uludag
- Second Department of General Surgery, Sisli Etfal Training and Research Hospital, Sisli, Istanbul, Turkey.
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Diller R, Stratmann U, Minin E, von Eiff C, Bäumer G, Huismans H, Helmschmied T, Becker K, Spiegel HU. ATIII attenuates endotoxemia induced healing impairment in the colon. J Surg Res 2008; 157:4-13. [PMID: 19589540 DOI: 10.1016/j.jss.2008.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 10/06/2008] [Accepted: 10/07/2008] [Indexed: 01/27/2023]
Abstract
BACKGROUND Intra-abdominal infections are considered a contributing factor to the impairment of anastomotic healing in patients undergoing surgical procedures of digestive system. Antithrombin (ATIII) is known to improve the microcirculation in sepsis. We hypothesized that it may also positively influence the healing of the colon anastomoses under endotoxemia. MATERIALS AND METHODS Ninety Balb/c mice (n = 10 per group on day 2, 4, and 7) were randomly assigned to three groups: Control (N), Sepsis (S) (administration of lipopolysaccharides (LPS) dosed at 2 mg/kg bodyweight, 18 h before colon surgery), and Sepsis with ATIII therapy (SIII) (administration of LPS and ATIII). All the animals underwent colonic anastomoses. Immediately after their completion, microcirculatory parameters were measured, and both macroscopic and histological parameters were assessed on day 2, 4, and 7 postoperation. Additionally, immunohistology studies were performed for CD31, ssDNA, and iNOS, along with an examination for bacterial translocation to the mesenteric lymph nodes. RESULTS Compared with group S, the functional capillary network was denser in the control group N (P < 0.001) and group SIII (P < 0.01). Mean bursting pressures were significantly lower in group S compared with group N, on day 2, 4, and 7, and with group SIII on day 2 and 7. At the anastomosis, the inflammatory infiltrate in group S was denser compared with groups N (P < 0.001) and SIII (P < 0.01). Furthermore, the apoptotic rate was higher, and the vascular density was lower on day 7 in group S compared with groups SIII and N (P < 0.05). Bacterial translocation decreased over time (P < 0.05) with no significant differences between the groups. CONCLUSION ATIII improved the anastomotic microcirculatory parameters and anastomotic healing in mice with endotoxemia, though the improvement failed to achieve the levels of the control mice.
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Affiliation(s)
- Ricarda Diller
- Department of General Surgery, University Hospital of Münster, Germany.
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Teke Z, Sacar M, Yenisey C, Atalay AO, Bicakci T, Erdem E. Activated protein C prevents deleterious effects of remote reperfusion injury caused by intestinal ischemia on wound healing in the left colonic anastomoses: an experimental study in the murine model. Am J Surg 2008; 196:774-87. [PMID: 18466864 DOI: 10.1016/j.amjsurg.2007.09.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2007] [Revised: 09/13/2007] [Accepted: 09/13/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Activated protein C (APC) is a serine protease with anticoagulant and antiinflammatory activities. The delaying effects of remote reperfusion injury on the wound-healing process in colonic anastomoses have been previously shown. In this study, we aimed to investigate whether APC protects against deleterious systemic effects of intestinal ischemia/reperfusion (I/R) injury on colonic anastomotic wound healing process. METHODS Male Wistar-albino rats were randomly allocated into 4 groups, and a left colonic anastomosis was performed in all animals: (1) sham-operated group, simultaneously with left colonic anastomosis, the superior mesenteric artery and collateral branches were divided from the celiac axis, and the inferior mesenteric artery were isolated but not occluded (group 1, n = 12), (2) sham + APC group, identical to group 1 except for APC treatment (100 microg/kg, intravenously, 15 minutes before construction of the colonic anastomosis), (group 2, n = 12), (3) intestinal I/R group, 60 minutes of superior mesenteric ischemia followed by reperfusion (group 3, n = 12), and (4) APC-treated group, (100 microg/kg, intravenously, 15 minutes before reperfusion) (group 4, n = 12). All animals were sacrificed, and colonic anastomotic bursting pressures were measured in vivo on day 7. Tissue samples were obtained for analysis of hydroxyproline contents, nitrate/nitrite levels, and activities of oxidative and antioxidative enzymes. The plasma levels of proinflammatory cytokines and D-dimer were also measured. RESULTS Intestinal I/R led to significant decreases in colonic anastomotic bursting pressures, tissue hydroxyproline contents, and activities of antioxidative enzymes, along with increases in tissue nitrate/nitrite levels, activities of oxidative enzymes, and plasma levels of proinflammatory cytokines and D-dimer (P < .05). However, APC treatment led to significant increases in colonic anastomotic bursting pressures, tissue hydroxyproline contents, and activities of antioxidative enzymes, along with decreases in tissue nitrate/nitrite levels, activities of oxidative enzymes, and plasma levels of proinflammatory cytokines and D-dimer (P < .05). CONCLUSION This study clearly showed that APC treatment prevented the delaying effects of remote I/R injury on colonic anastomotic wound healing process. Further clinical studies are required to determine whether APC has a useful role in the enhancement of colonic anastomotic wound healing after particular operations in which I/R injury occurs.
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Affiliation(s)
- Zafer Teke
- Department of General Surgery, Pamukkale University, School of Medicine, 20070, Kinikli, Denizli, Turkey.
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Diller R, Stratmann U, Helmschmied T, Bäumer G, Bahde R, Minin E, Spiegel HU. Microcirculatory Dysfunction in Endotoxemic Bowel Anastomosis: The Pathogenetic Contribution of Microcirculatory Dysfunction to Endotoxemia-Induced Healing Impairment. J Surg Res 2008; 150:3-10. [DOI: 10.1016/j.jss.2007.12.795] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2007] [Revised: 12/11/2007] [Accepted: 12/19/2007] [Indexed: 11/16/2022]
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How can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or Hartmann's/Miles' operation? J Gastrointest Surg 2008; 12:1995-2000. [PMID: 18636300 DOI: 10.1007/s11605-008-0582-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Accepted: 06/16/2008] [Indexed: 01/31/2023]
Abstract
PURPOSE Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI. METHODS Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT). RESULTS The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups. CONCLUSION Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.
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Teke Z, Sacar S, Yenisey C, Atalay AO, Kavak T, Erdem E. Role of activated protein C on wound healing process in left colonic anastomoses in the presence of intra-abdominal sepsis induced by cecal ligation and puncture: an experimental study in the rat. World J Surg 2008; 32:2434-43. [PMID: 18679745 DOI: 10.1007/s00268-008-9696-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2007] [Accepted: 06/23/2008] [Indexed: 01/27/2023]
Abstract
BACKGROUND Activated protein C (APC) is a serine protease with anticoagulant and anti-inflammatory activities. The delaying effects of intra-abdominal sepsis on wound healing process in colonic anastomoses have been previously demonstrated. This study was designed to investigate the role of APC on wound healing process in left colonic anastomoses in the presence of intra-abdominal sepsis. METHODS The left colonic anastomosis was performed in 48 rats that were divided into four groups: (1) sham-operated group, laparatomy plus cecal mobilization (n = 12); (2) sham + APC group, identical to group I except for APC treatment (n = 12); (3) CLP group, cecal ligation and puncture (n = 12); 4) CLP + APC-treated group, 100 microg/kg, 15 min before the construction of colonic anastomosis (n = 12). Anastomotic bursting pressures were measured in vivo on day 7. Tissue samples were obtained for analyses of hydroxyproline (HP) contents, myeloperoxidase (MPO) acivity, malondialdehyde (MDA), and nitrate/nitrite (NO3(-) /NO2(-)) levels. The plasma levels of tumor necrosis factor alpha (TNF-alpha), interleukin (IL)-6, and D-dimer also were measured. RESULTS Intra-abdominal sepsis led to significant decreases in colonic anastomotic bursting pressures and tissue HP contents, along with increases in MPO activity, MDA and NO3(-) /NO2(-) levels, and also plasma levels of TNF-alpha, IL-6, and D-dimer (P < 0.05). However, APC treatment led to significant increases in anastomotic bursting pressures and tissue HP ontents, along with decreases in MPO activity, MDA and NO3(-) /NO2(-) levels, and also plasma levels of TNF-alpha, IL-6, and D-dimer (P < 0.05). CONCLUSIONS This study clearly showed that APC treatment prevented the delaying effects of intra-abdominal sepsis on colonic anastomotic wound healing process. Further clinical studies are required to determine whether APC has a useful role in the enhancement of anastomotic healing during particular surgeries in which sepsis-induced injury occurs.
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Affiliation(s)
- Zafer Teke
- Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Hospital, 06100, Sihhiye, Ankara, Turkey.
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Tsereteli Z, Sporn E, Geiger TM, Cleveland D, Frazier S, Rawlings A, Bachman SL, Miedema BW, Thaler K. Placement of a covered polyester stent prevents complications from a colorectal anastomotic leak and supports healing: randomized controlled trial in a large animal model. Surgery 2008; 144:786-92. [PMID: 19081022 DOI: 10.1016/j.surg.2008.05.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Accepted: 05/29/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anastomotic leaks after colorectal operation continue to be a significant cause of morbidity. A covered endoluminal stent could seal a leak and eliminate the need for diversion. The aim of this study was to test the efficacy of a temporary covered stent to prevent leak related complications. METHODS Sixteen adult pigs (80-120 lbs) underwent open transection of the rectosigmoid followed by anastomosis with a circular stapler. Eight animals (study group) underwent endoscopic placement of a 21-mm covered polyester stent. Eight control group animals were left without stents. In all animals, a 2-cm leak was created along the anterior portion of the anastomosis. The animals were killed after 2 weeks and evaluated for abdominal infection, fistulae, and adhesions. The anastomosis was excised and the following parameters were assessed by a pathologist blinded to treatment: mucosal interruption (mm), inflammatory response, collagen type I and III, granulation, and fibrosis (grade 0-4). RESULTS Stents were spontaneously expelled between postoperative days 6 and 9. At necropsy, none of the animals in the study group had leak related complications, whereas in the control group, 5 (63%) developed intraabdominal infection (4 abscesses, 1 fistula) at the anastomosis (P = .002). Dense adhesions to the anastomosis were found in 7 (88%) control animals. On histology, anastomotic sites in the study group had significantly less mucosal interruption and granulation. Two pigs in the study group died on postoperative day 7, one due to evisceration and one from bladder necrosis. The mortality result is not different from controls (P = .47), both events seem to be unrelated to stent placement. CONCLUSION Temporary placement of a covered polyester stent across a colorectal anastomosis prevents leak-related complications and supports the healing of anastomotic leaks.
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Affiliation(s)
- Zurab Tsereteli
- Department of General Surgery, University of Missouri, Columbia, MO 65212, USA
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Teke Z, Aytekin FO, Kabay B, Yenisey C, Aydin C, Tekin K, Sacar M, Ozden A. Pyrrolidine dithiocarbamate prevents deleterious effects of remote ischemia/reperfusion injury on healing of colonic anastomoses in rats. World J Surg 2007; 31:1835-1842. [PMID: 17566823 DOI: 10.1007/s00268-007-9106-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pyrrolidine dithiocarbamate (PDTC) is a low-molecular-weight thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. It has been shown to attenuate local harmful effects of ischemia/reperfusion (I/R) injury in many organs. In recent animal studies, a delaying effect of remote organ I/R injury on the healing of colonic anastomoses has been demonstrated. In this study we investigated whether PDTC prevents harmful systemic effects of superior mesenteric I/R on left colonic anastomosis in rats. METHODS Anastomosis of the left colon was performed in 40 rats randomly allocated into the following four groups: (1) Sham-operated group (group I, n = 10)-simultaneously with colonic anastomosis, the superior mesenteric artery and collateral branches divided from the celiac axis and the inferior mesenteric artery were isolated but not occluded. (2) Sham+PDTC group (group II, n = 10)-identical to sham-operated rats except for the administration of PDTC (100 mg/kg IV bolus) 30 minutes prior to commencing the experimental period. (3) I/R group (group III, n = 10)-60 minutes of intestinal I/R by superior mesenteric artery occlusion. (4) PDTC-treated group (group IV, n = 10)-PDTC 100 mg/kg before and after the I/R. On postoperative day 6, all animals were sacrificed, and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for investigation of anastomotic hydroxyproline (HP) contents, perianastomotic malondialdehyde (MDA) levels, myeloperoxidase activity (MPO), and glutathione (GSH) level. RESULTS There was a statistically significant decrease in anastomotic bursting pressure values, tissue HP content and GSH level, along with an increase in MDA level and MPO activity in group III, when compared to groups I, II, and IV (p < 0.05). However, PDTC treatment led to a statistically significant increase in anastomotic bursting pressure values, tissue HP content and GSH level, along with a decrease in MDA level and MPO activity in group IV (p < 0.05). CONCLUSIONS This study showed that PDTC treatment significantly prevented the delaying effect of remote organ I/R injury on anastomotic healing in the colon. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent for increasing the safety of the anastomosis during particular operations where remote organ I/R injury occurs.
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Affiliation(s)
- Zafer Teke
- Department of General Surgery, Pamukkale University, Faculty of Medicine, 20070, Kinikli, Denizli, Turkey.
| | - Faruk Onder Aytekin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, 20070, Kinikli, Denizli, Turkey
| | - Burhan Kabay
- Department of General Surgery, Pamukkale University, Faculty of Medicine, 20070, Kinikli, Denizli, Turkey
| | - Cigdem Yenisey
- Department of Biochemistry, Adnan Menderes University, Faculty of Medicine, 09100, Aydin, Turkey
| | - Cagatay Aydin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, 20070, Kinikli, Denizli, Turkey
| | - Koray Tekin
- Department of General Surgery, Pamukkale University, Faculty of Medicine, 20070, Kinikli, Denizli, Turkey
| | - Mustafa Sacar
- Department of Cardiovascular Surgery, Pamukkale University, Faculty of Medicine, 20070, Kinikli, Denizli, Turkey
| | - Akin Ozden
- Department of General Surgery, Pamukkale University, Faculty of Medicine, 20070, Kinikli, Denizli, Turkey
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Li Y, Bao Y, Jiang T, Tan L, Liu F, Li J. Combination of fibrin glue with growth hormone augments healing of incomplete intestinal anastomoses in a rat model of intra-abdominal sepsis: a dynamic study. J INVEST SURG 2007; 20:301-6. [PMID: 17972218 DOI: 10.1080/08941930701598826] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study was devised to investigate whether fibrin glue (FG) in combination with growth hormone (GH) could have a beneficial effect at a late period (14 days) after injury. Male Wistar rats, with abdominal sepsis induced by an incomplete anastomosis, were divided into three groups. In the control group, the rats got incomplete anastomoses sutured alone; in the FG and FG/GH groups, anastomoses protection was performed with application of FG alone or in combination with GH. The anastomotic bursting pressure (ABP) was significantly higher in the FG/GH group than that of the FG group on postoperative day (POD) 5 (p < .01), while it could not be measured from POD 7 to POD 14 because of intestinal dehiscence. There was no difference between FG and FG/GH group on POD 3 and POD 5 in anastomotic tensile strength, which was significantly higher in the FG/GH group than that of the FG group from POD 7 to POD 14 (p < .001). Hydroxyproline content of the FG/GH group was significantly higher than that of the control from POD 3 and that of the FG group from POD 5 (p < .05). Combination of FG with GH had a synergistic effect to improve intestinal anastomotic healing over a limited 14-day course of observation.
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Affiliation(s)
- Yousheng Li
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
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Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, Shamsah A, Zarka ZA, Al-Hajj H, Al-Momen A. Risk Factors for Wound Complication in Pilonidal Sinus Procedures. J Am Coll Surg 2007; 205:439-44. [PMID: 17765160 DOI: 10.1016/j.jamcollsurg.2007.04.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 04/21/2007] [Accepted: 04/24/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pilonidal disease is a common condition among young people. Complicated pilonidal surgical wounds are associated with considerable morbidity, including chronic sacral wound, loss of work time, and lifestyle limitation. The aim of our study is to report our experience with Karydakis procedure and explore the risk factors associated with infection and poor healing in pilonidal operation. STUDY DESIGN A 3-year experience of a Joint-Commission International accredited tertiary center in patients with pilonidal sinus operations is reported. We retrospectively reviewed the charts of unselected patients with pilonidal sinus who underwent excision and primary closure on elective basis in terms of wound healing, surgical site infection, and return to work. Variables predictive of surgical site infection and disruption were assessed by multiple logistic analyses. RESULTS From January 2004 to December 2006, 94 patients with pilonidal disease underwent excision and primary closure on elective basis. Incidence of surgical site infection was 12.8%. No recurrence was observed after median followup of 6 months, with interquartile range of 4 to 9 months. Smoking (p = 0.027) and obesity (p = 0.047) were independent risk factors for wound infections. CONCLUSIONS Excision and primary closure is an acceptable modality of treatment in nonobese and nonsmoker patients with pilonidal sinus disease. Infection rate in obese patients and smokers is unacceptably high, and active preoperative weight loss and smoking cessation or simple laid open procedure is recommended in these patients.
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Affiliation(s)
- Haitham Al-Khayat
- Department of Surgery, Saad Specialist Hospital, Al-Khobar, Saudi Arabia.
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Aytekin FO, Teke Z, Aydin C, Kabay B, Yenisey C, Sacar S, Demir EM, Tekin K. Effects of a membrane-permeable radical scavenger, Tempol, on healing of colonic anastomoses in the cecal ligation and puncture model of polymicrobial sepsis in rats. Am J Surg 2007; 193:723-9. [PMID: 17512284 DOI: 10.1016/j.amjsurg.2006.06.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 06/04/2006] [Accepted: 06/04/2006] [Indexed: 01/27/2023]
Abstract
BACKGROUND Tempol (Sigma-Aldrich, Steinheim, Germany) is a stable piperidine nitroxide of low molecular weight that permeates biologic membranes and scavenges superoxide anions in vitro. In recent animal studies, the delaying effect of intraperitoneal sepsis on the healing of colonic anastomoses has been shown. In this study we aimed to investigate the effects of Tempol on the healing of colonic anastomoses in the presence of polymicrobial sepsis. METHODS Anastomosis of the left colon was performed on the day after cecal ligation and puncture (CLP) in 30 rats that were divided into 3 groups: sham-operated control (laparotomy and cecal mobilization, group I, n = 10), CLP (group II, n = 10), Tempol-treated group (30 mg/kg intravenously before the construction of colonic anastomosis, group III, n = 10). On postoperative day 6, all animals were killed and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for further investigation of anastomotic hydroxyproline (HP) contents, perianastomotic myeloperoxidase (MPO) activity, malondialdehyde (MDA), and glutathione (GSH) levels. RESULTS There was a statistically significant increase in MPO activity and MDA levels in the CLP group (group II), along with a decrease in GSH levels, anastomotic HP contents, and bursting pressure values when compared with controls (group I). However, Tempol treatment led to a statistically significant increase in anastomotic bursting pressure values, tissue HP contents, and GSH levels, along with a decrease in MPO activity and MDA levels in group III (P < .05). CONCLUSIONS This study showed that Tempol treatment significantly prevented the delaying effect of CLP-induced polymicrobial sepsis on anastomotic healing in the left colon. Further clinical studies are needed to clarify whether Tempol may be a useful therapeutic agent to increase the safety of the anastomosis during particular surgeries in which sepsis-induced organ injury occurs.
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Affiliation(s)
- Faruk Onder Aytekin
- Faculty of Medicine, Department of General Surgery, Pamukkale University, 20070 Kinikli, Denizli, Turkey
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Vasiliadis K, Pramateftakis MG, Blouhos K, Mantzoros I, Koliakos G, Zaraboukas T, Kanellos I, Demetriades H, Alamdari DH, Betsis D. Effect of iloprost on impaired anastomotic healing caused by 5-fluorouracil plus leucovorin. Dis Colon Rectum 2007; 50:899-907. [PMID: 17353975 DOI: 10.1007/s10350-006-0878-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE This experimental study was designed to investigate whether iloprost can reverse impaired colonic healing caused by immediate postoperative intraperitoneal administration of 5-fluorouracil plus leucovorin. METHODS Eighty Wistar rats were randomized into four groups. After resection of a 1-cm segment of transverse colon, an end-to-end sutured anastomosis was generated. Rats received saline solution (Group 1), 5-fluorouracil plus leucovorin (Group 2), iloprost (Group 3), and 5-fluorouracil plus leucovorin plus iloprost (Group 4) intraperitoneally from the day of operation and once daily until killing. Each group was further randomized into two subgroups. Subjects were killed on the fifth (Subgroup a) and eighth (Subgroup b) postoperative days. After killing, anastomoses were examined macroscopically and graded histologically. Rats were measured for anastomotic bursting pressures and tissue hydroxyproline levels. RESULTS The leakage rate of the anastomoses was significantly higher in the 5-fluorouracil plus leucovorin group compared with the other groups (P = 0.049). Bursting pressure was significantly lower in 2a subgroup (5-fluorouracil plus leucovorin, postoperative Day 5) than in 4a (5-fluorouracil plus leucovorin plus iloprost, postoperative Day 5; P < 0.001). Adhesion formation was significantly higher in all b subgroups compared with the Control b subgroup. Neoangiogenesis was significantly higher in iloprost and iloprost plus 5-fluorouracil plus leucovorin subgroups compared with the 5-fluorouracil plus leucovorin subgroups. Hydroxyproline levels, collagen deposition, fibroblasts, and white cell count were significantly higher in the iloprost plus 5-fluorouracil plus leucovorin b subgroup (postoperative Day 8) compared with the 5-fluorouracil plus leucovorin b subgroup (postoperative Day 8). CONCLUSIONS The immediate postoperative, intraperitoneal administration of iloprost counteracts and reverses the negative effects of 5-fluorouracil plus leucovorin chemotherapy and protects colonic healing in rats.
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Affiliation(s)
- K Vasiliadis
- Fourth Department of Surgery, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Aydin C, Teke Z, Aytekin F, Yenisey C, Kabay B, Simsek NG, Tekin K. Tempol prevents harmful effects of remote ischemia reperfusion injury on healing of experimental colonic anastomoses. Int J Colorectal Dis 2007; 22:325-31. [PMID: 16718449 DOI: 10.1007/s00384-006-0149-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2006] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Tempol (4-hydroxy-2,2,6,6-tetramethylpiperidine-N-oxyl) is a water-soluble analogue of the spin label TEMPO. As an antioxidative agent, it is a member of nitroxides, which detoxifies superoxide and possibly other toxic radicals in vivo. In this study, we aimed to investigate whether tempol prevents harmful systemic effects of superior mesenteric ischemia-reperfusion on left colonic anastomosis in rats. MATERIALS AND METHODS Anastomosis of the left colon was performed in 30 rats that were divided into three groups each having ten animals: sham-operated control (group I), 60 min of intestinal ischemia-reperfusion by superior mesenteric artery occlusion (group II), and tempol-treated group (30 mg/kg before and after the ischemia-reperfusion (group III). On postoperative day 5, all animals were killed and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for further investigation of anastomotic hydroxyproline content, perianastomotic malondialdehyde, and glutathione levels. RESULTS There was a statistically significant increase in the quantity of myeloperoxidase activity and malondialdehyde levels in group II, along with a decrease in glutathione levels, anastomotic hydroxyproline content, and bursting pressure values when compared to controls. However, all of the investigated parameters were normalized in tempol-treated animals (group III). CONCLUSION We conclude that tempol significantly prevents harmful systemic effects of reperfusion injury on colonic anastomoses in a rat model of superior mesenteric artery occlusion.
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Affiliation(s)
- Cagatay Aydin
- Faculty of Medicine, Genel Cerrahi Anabilim Dali, Kinikli, Pamukkale University, Denizli, 20070, Turkey.
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Teke Z, Aytekin FO, Aydin C, Kabay B, Yenisey C, Sacar S, Simsek NG, Tekin K. Effects of pyrrolidine dithiocarbamate on healing of colonic anastomoses in the cecal ligation and puncture model of intraperitoneal sepsis in rats. World J Surg 2007; 31:200-9. [PMID: 17180567 DOI: 10.1007/s00268-006-0013-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Pyrrolidine dithiocarbamate (PDTC) is a low-molecular thiol antioxidant and potent inhibitor of nuclear factor-kappaB (NF-kappaB) activation. In recent animal studies, the delaying effect of intraperitoneal sepsis on healing of colonic anastomoses has been demonstrated. In this study, we aimed to investigate the effects of PDTC on healing of colonic anastomoses in the presence of intraperitoneal sepsis induced by a rodent model of cecal ligation and puncture (CLP). METHODS Anastomosis of the left colon was performed on the day following CLP in 30 rats that were divided into three groups: sham-operated control (laparotomy and cecal mobilization, group I, n =10), cecal ligation and puncture (CLP) (group II, n = 10), PDTC-treated group (100 mg/kg IV before construction of the colonic anastomosis) (group III, n = 10). On postoperative day 6, all animals were sacrificed, and anastomotic bursting pressures were measured in vivo. Tissue samples were obtained for further investigation of colonic anastomotic hydroxyproline (HP) contents, perianastomotic myeloperoxidase (MPO) activity, and malondialdehyde (MDA) and glutathione (GSH) levels. RESULTS There was a statistically significant increase in the activity of MPO and MDA levels in the CLP group (group II) along with a decrease in GSH levels, colonic anastomotic HP contents, and bursting pressure values when compared to controls (group I). However, PDTC treatment led to a statistically significant increase in the tissue HP contents, GSH levels, and colonic anastomotic bursting pressure values, along with a decrease in MPO activity and MDA levels in group III (p < 0.05). CONCLUSIONS This study showed that PDTC treatment significantly prevented the delaying effect of CLP-induced intraperitoneal sepsis on anastomotic healing in the colon. Further clinical studies are needed to clarify whether PDTC may be a useful therapeutic agent to increase the safety of the anastomosis during particular operations where sepsis-induced injury occurs.
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Affiliation(s)
- Zafer Teke
- Department of General Surgery, Pamukkale University Faculty of Medicine, 20070, Kinikli, Denizli, Turkey.
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Gunerhan Y, Koksal N, Gul O, Uzun MA, Guneş P, Adaleti R. Effects of unfractionated heparin and low-molecular-weight heparin on colonic anastomoses in the presence of experimental peritonitis. Eur Surg Res 2006; 38:353-7. [PMID: 16804312 DOI: 10.1159/000094257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Accepted: 05/15/2006] [Indexed: 01/21/2023]
Abstract
BACKGROUND We aimed at investigating the effects of unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) on the healing process of colonic anastomoses in the presence of peritonitis which is known to adversely affect the healing process. STUDY DESIGN Three groups of Wistar albino rats (n = 15 in each group) with experimental fecal peritonitis were studied. A 1-cm colonic segment was resected, and an end-to-end anastomosis was performed. The control group (group 1) was given no treatment; group 2 animals received 50 IU/kg s.c. UFH twice a day, and group 3 rats received LMWH at a dose of 1.5 mg/kg daily for 7 days postoperatively. Relaparotomy was done on day 7 in the surviving rats. The rats were sacrificed by resection of the colonic segment. The anastomosis bursting pressures were measured and the tissue samples from anastomosis lines were histopathologically examined. RESULTS The bursting pressures were significantly higher in UFH and LMWH groups as compared with the controls (p = 0.021 and p < 0.001, respectively), while there was no statistically significant difference between UFH and LMWH groups. Positive bacterial culture results were more common in controls (90%) than in the other two groups (p = 0.029 and p = 0.002, respectively). Also the polymorphonuclear leukocyte counts were higher (p = 0.005) and the fibrin formation more common (p = 0.007) in the controls. On the other hand, the number of fibroblasts was higher (p = 0.002) and collagen formation and revascularization more frequent (p = 0.001 and p = 0.001, respectively) in the UFH and LMWH groups. CONCLUSION UFH and LMWH may have positive effects on the healing process of colonic anastomoses in the presence of peritonitis.
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Affiliation(s)
- Yusuf Gunerhan
- 2nd Surgical Clinics, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey.
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McGrath A, Porrett T, Heyman B. Parastomal hernia: an exploration of the risk factors and the implications. ACTA ACUST UNITED AC 2006; 15:317-21. [PMID: 16628167 DOI: 10.12968/bjon.2006.15.6.20679] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Risk may be defined as 'the chance that something may happen to cause loss or an adverse effect' (Concise Oxford Medical Dictionary, 2003). Patients undergoing stoma formation are at risk of developing a wide range of complications following surgery. A parastomal hernia is an adverse effect that can contribute to postoperative morbidity. The risk of developing a parastomal hernia is dependent upon a number of variables, and stoma care nurses need to be aware of these to plan the appropriate care for patients undergoing stoma formation. This article discusses the issues surrounding the development of parastomal hernias and also looks at ways in which the risk factors associated with the development of a parastomal hernia may be minimized.
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Affiliation(s)
- Anthony McGrath
- St Bartholomew School of Nursing and Midwifery, City University London, UK
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Li Y, Bao Y, Jiang T, Tan L, Gao Y, Li J. Effect of the Combination of Fibrin Glue and Growth Hormone on Incomplete Intestinal Anastomoses in a Rat Model of Intra-Abdominal Sepsis. J Surg Res 2006; 131:111-7. [PMID: 16297407 DOI: 10.1016/j.jss.2005.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 08/31/2005] [Accepted: 09/07/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The presence of established intra-abdominal sepsis has been considered a contraindication to primary anastomoses. Our hypothesis was that fibrin glue (FG), growth hormone (rhGH), and combination of them synergistically improve intestinal primary anastomotic healing in a rat model of intestinal fistulae with peritonitis. MATERIALS AND METHODS Male Wistar rats, induced intestinal fistulae with peritonitis after 24 h, were performed an enterectomy and intestinal anastomoses. Group A, rats (n = 60) had a complete anastomoses (end-to-end single layer anastomoses using 12 inverted interrupted 6-0 sutures) without peritonitis, group B, rats (n = 60) had a complete anastomoses after 24 h of peritonitis, group C rats had an incomplete anastomoses (four inverted interrupted sutures), groups D, E, F rats (n = 60) received FG, rhGH, or both of them, respectively. rhGH was given daily for 5 days. Anastomoses indicated the anastomotic bursting pressure (ABP), tensile strength, and hydroxyproline content, were determined. RESULTS On POD 1, ABP of group C and group D was significantly lower than that of other groups (P < 0.01); On POD 3, ABP could not be determined because of intestinal dehiscence in groups C and E, ABP was significantly higher in groups D and F than that of groups A and B (P < 0.01); the ABP increased after 5 days of operation in groups A, B, and F. At the same time, that of group D decreased (P < 0.01). On POD 5, the tensile strength was significantly higher in groups A, D, and F than that in groups C, and E. On POD 5, hydroxyproline content was higher in groups D and F compared to that in group C (P < 0.05). CONCLUSIONS These data suggested that FG improve intestinal primary anastomotic healing within post-operative 5 days in a rat model of intestinal fistulae with peritonitis. RhGH alone fails to improve intestinal anastomotic healing, and the combination of FG and rhGH have no synergistic effect to improves intestinal anastomotic healing.
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Affiliation(s)
- Yousheng Li
- Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
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Patriti A, Contine A, Carbone E, Gullà N, Donini A. One-stage resection without colonic lavage in emergency surgery of the left colon. Colorectal Dis 2005; 7:332-8. [PMID: 15932554 DOI: 10.1111/j.1463-1318.2005.00812.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Intra-operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left-sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon. PATIENTS AND METHODS All 44 patients (29 with obstruction and 15 with perforation) on whom a one-stage left-sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures. RESULT The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications. CONCLUSION The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage.
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Affiliation(s)
- A Patriti
- General and Emergency Surgery, Department of Surgery, University of Perugia, Perugia, Italy.
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Sørensen LT, Hemmingsen U, Kallehave F, Wille-Jørgensen P, Kjaergaard J, Møller LN, Jørgensen T. Risk factors for tissue and wound complications in gastrointestinal surgery. Ann Surg 2005; 241:654-8. [PMID: 15798468 PMCID: PMC1357070 DOI: 10.1097/01.sla.0000157131.84130.12] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Surgical site infections and disruption of sutured tissue are frequent complications following surgery. We aimed to assess risk factors predictive of tissue and wound complications in open gastrointestinal surgery. METHODS Data from 4855 unselected patients undergoing open gastrointestinal surgery from 1995 through 1998 were recorded in a clinical database and validated. The database embraced variables related to patient history, preoperative clinical condition, operative findings and severity, and the surgeon's training. Variables predictive of surgical site infection and dehiscence of sutured tissue within 30 days after surgery were assessed by multiple logistic regression analysis. RESULTS Following elective operation, the incidence of tissue and wound complications was 6% compared with 16% in emergency surgery (P < 0.001). These complications resulted in prolonged hospitalization in 50% of the patients and a 3-fold higher risk of reoperation but not increased mortality. Factors associated with complications following elective operations were smoking, comorbidity, and perioperative blood loss. Following emergency operations, male gender, peritonitis, and multiple operations were predictors of complications. Irrespective of elective or emergency surgery, the type of operation was a predictor of complications. CONCLUSION Factors known to affect the process of tissue and wound healing are independently associated with tissue and wound complications following gastrointestinal surgery.
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Affiliation(s)
- Lars Tue Sørensen
- Department of Surgical Gastroenterology, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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