The adverse effects of octreotide on the healing of colonic anastomoses in rats

An updated systematic review and meta-analysis of the use of octreotide for the prevention of postoperative complications after pancreatic resection

BACKGROUND

The use of octreotide prophylaxis following pancreatic surgery is controversial. We aimed to evaluate the effectiveness of octreotide for the prevention of postoperative complications after pancreatic surgery through this systematic review and meta-analysis.

METHODS

Literature databases (including the MEDLINE, EMBASE, and Cochrane databases) were searched systematically for relevant articles. Only randomized controlled trials (RCTs) were eligible for inclusion in our research. We extracted the basic information regarding the patients, intervention procedures, and all complications after pancreatic surgery and then performed the meta-analysis.

RESULTS

Thirteen RCTs involving 2006 patients were identified. There were no differences between the octreotide group and the placebo group with regard to pancreatic fistulas (PFs) (relative risk [RR] = 0.79, 95% confidence interval [CI] = 0.62-0.99, P = .05), clinically significant PFs (RR = 1.01, 95% CI = 0.68-1.50, P = .95), mortality (RR = 1.21, 95% CI = 0.78-1.88, P = .40), biliary leakage (RR 0.84, 95% CI = 0.39-1.82, P = .66), delayed gastric emptying (RR = 0.83, 95% CI = 0.54-1.27, P = .39), abdominal infection (RR = 1.00, 95% CI = 0.66-1.52, P = 1.00), bleeding (RR = 1.16, 95% CI = 0.78-1.72, P = .46), pulmonary complications (RR = 0.73, 95% CI = 0.45-1.18, P = .20), overall complications (RR = 0.80, 95% CI = 0.64-1.01, P = .06), and reoperation rates (RR = 1.18, 95% CI = 0.77-1.81, P = .45). In the high-risk group, octreotide was no more effective at reducing PF formation than placebo (RR = 0.81, 95% CI = 0.67-1.00, P = .05). In addition, octreotide had no influence on the incidence of PF (RR = 0.38, 95% CI = 0.14-1.05, P = .06) after distal pancreatic resection and local pancreatic resection.

CONCLUSION

The present best evidence suggests that prophylactic use of octreotide has no effect on reducing complications after pancreatic resection.

Effect of mesalamine on healing in experimental colon anastomosis: a randomised experimental study

OBJECTIVE

We aimed to investigate the effect of mesalamine on healing of experimental colon anastomosis model.

MATERIAL/METHODS

Forty adult male Wistar albino rats were performed segmentary colonic resection and end-to-end anastomosis. Animals were randomly divided into four groups: group I, anastomosis group, received no treatment (GI, n=8); group II, anastomosis+oral mesalamine group (100mg/kg/day); group III, anastomosis+rectal mesalamine (2mL) group, (GIII, n=8); group IV, anastomosis+oral mesalamine+rectal mesalamine (GIV, n=8) group. A sham group (n=8) was constituted and was performed laparotomy. Bursting pressure, hydroxyproline levels and histopathological characteristics of the anastomosis were analyzed.

RESULTS

Although it was not statistically significant, there was an increase in the burst pressure of the mesalamine group. When hydroxyproline measurements were compared there were statistically significant difference between the non-treated colon and all groups. There were significant differences between GI and GIII-GIV, GII and GIV. The differences between group I and II and group II and III were not statistically significant. When we compared the median amount of the histopathological changes, we found significant difference between the anastomosis and the mesalamine groups (P<0.05). But when mesalamine groups were compared with each other we did not observe a significant difference.

CONCLUSION

Mesalamine had positive effects which were not statistically significant on bursting pressure and statistically different significant effects on hydroxyproline (HP) levels based on the way of administration and statistically significant positive effects on histopathologic anastomotic healing in experimental anastomosis model.

Effect of propolis on healing in experimental colon anastomosis in rats

INTRODUCTION

Propolis is the generic name for the resinous substance collected by honeybees, which is known to have antioxidant, anti-inflammatory, apoptosis-inducible effects. Anastomotic dehiscence after colorectal surgery is an important cause of morbidity and mortality. We aimed to assess the effect of propolis on healing in an experimental colon anastomosis in rats.

METHODS

Forty adult male Wistar albino rats were randomly assigned into 5 treatment groups with 8 rats in each: Group I, anastomosis+no treatment; Group II, anastomosis+oral propolis (600 mg/kg/d); Group III, anastomosis+oral ethyl alcohol (1 cc/d); Group IV, anastomosis+rectal propolis (600 mg/kg/d); Group V, anastomosis+rectal ethyl alcohol (1 cc/d). The bursting pressures, hydroxiproline levels and histopathological changes in each group were measured.

RESULTS

When bursting pressures were compared between groups, we observed that they were increased in the groups treated with propolis in contrast to all other groups. Hydroxiproline levels in the propolis groups were also significantly increased in contrast to the other groups. There was also a statistically significant difference in histopathological changes between the treatment types. When propolis administration methods were compared, we did not observe a statistically significant difference.

CONCLUSION

Propolis has a significantly favourable effect on healing in experimental colon anastomosis, independent from the method of administration.

Efficacy of somatostatin and its analogues in prevention of postoperative complications after pancreaticoduodenectomy: a meta-analysis of randomized controlled trials

OBJECTIVE

The aim of this study was to evaluate the efficacy of somatostatin and its analogues in prevention of postoperative complications after pancreaticoduodenectomy.

METHODS

A literature search of the MEDLINE, EMBASE, and Cochrane databases was used to identify randomized controlled trials that compared somatostatin and its analogues with control group after pancreaticoduodenectomy. Meta-analytical techniques were applied to identify differences in outcomes between the 2 groups.

RESULTS

A total of 8 studies were identified according to our inclusion criteria, including 2 studies using somatostatin, 5 studies using octreotide, and 1 study using vapreotide. The use of somatostatin or its analogues did not significantly benefit for reducing the incidence of pancreatic fistula (odds ratio [OR] 95% confidence interval [CI], 0.64-1.37; P = 0.73), total pancreas-specific postoperative complications (OR 95% CI, 0.63-1.42; P = 0.79), delayed gastric emptying (OR 95% CI, 0.50-1.78; P = 0.86), total complication (OR 95% CI, 0.73-1.70; P = 0.61), mortality (OR 95% CI, 0.59-7.72; P = 0.97), and length of postoperative hospital stay (weighted mean difference 95% CI, -7.74 to 4.47; P = 0.60).

CONCLUSIONS

The use of somatostatin and its analogues does not significantly reduce postoperative complications after pan-creaticoduodenectomy.

Influência do octreotide subcutâneo na cicatrização de sutura gástrica em ratos

RACIONAL: Octreotide, análogo sintético da somatostatina, é potente inibidor da secreção gástrica, intestinal e pancreática. Reduz fluxo sangüíneo esplâncnico, acelera esvaziamento gástrico e prolonga tempo de trânsito intestinal, estimulando a absorção de água e eletrólitos. Freqüentemente é utilizado no tratamento das fístulas digestivas pela sua capacidade de reduzir o débito da fístula, porém a redução do fluxo sangüíneo poderia interferir negativamente na cicatrização. OBJETIVO: Avaliar a influência do octreotide na cicatrização de sutura gástrica em ratos. MÉTODOS: Foram utilizados 39 ratos Wistar machos, divididos em dois grupos, controle e octreotide, subdivididos em 4 e 7 dias, de acordo com o dia da morte do animal. Todos foram submetidos à gastrotomia e fechamento com pontos seromusculares interrompidos. Os animais do grupo octreotide receberam dose única diária do medicamento por via subcutânea. O grupo controle recebeu solução salina a 0,9%. Foram determinados o percentual de colágeno maduro e imaturo, pela técnica de picrosirius-red F3BA. O cálculo do índice de maturação do colágeno e determinação da força de ruptura (FRT) e força máxima de tração (FMT), foi testada em tensiômetro computadorizado. Utilizou-se para análise estatística, os testes t de Student e Kruskal-Wallis com nível de significância de P<0,05. RESULTADOS: Na avaliação do colágeno imaturo não houve diferença estatisticamente significativa. Quanto ao maduro, no grupo controle, houve maior percentual no subgrupo do 7º dia pós-operatório (21,43±1,06 vs.11,26±1,44, P=0,0000). No grupo octreotide, não houve diferença entre os subgrupos. Na avaliação inter-grupos do colágeno maduro, a dosagem foi maior no 4º dia do pós-operatório do grupo octreotide (19,13±1,38 vs.11,26±1,44, P=0,001). O índice de maturação do colágeno maior para o grupo octreotide no 4º dia do pós-operatório (1,07±0,07 vs. 0,65±0,05, P=0,0001). A FMT e a FRT não apresentaram diferença entre os grupos. CONCLUSÕES: A administração de octreotide por via subcutânea aumenta a deposição de colágeno maduro e não altera a resistência tênsil de gastrorrafias em ratos.

The effect of octreotide on healing of injured colonic anastomosis with immediate postoperative intraperitoneal administration of 5-Fluorouracil

PURPOSE

This study was designed to investigate the effect of octreotide on side effects of immediate usage of 5-fluorouracil after colonic anastomosis.

METHODS

Forty male Wistar rats were randomly assigned into four groups and underwent standardized left colonic anastomosis. The rats served as control or received intraperitoneal 5-fluorouracil (20 mg/kg daily), subcutaneous octreotide (20 mug/kg daily), or both. Diarrhea and wound complications were noted during the experiment. The colonic anastomoses were assessed for healing on postoperative Day 7 by determining the anastomotic bursting pressure, performing histologic examination, and measuring the tissue hydroxyproline content, serum malondialdehyde, and nitric oxide levels. Intraperitoneal adhesions and anastomotic leakage were also noted.

RESULTS

No statistical significant difference was found between the control and octreotide groups for each of the parameters measured. Immediate 5-fluorouracil use resulted with higher adhesion score (P = 0.002), significant depression in anastomotic bursting pressure (P = 0.0001), histopathologic score (P = 0.0001), hydroxyproline content (P = 0.0001), and increasing nitric oxide (P = 0.0001) and malondialdehyde levels (P = 0.0001) compared with the control group. Diarrhea was seen in 80 percent of the 5-fluorouracil group but in neither the control nor octreotide groups (P = 0.0001 for each comparison). However, all these parameters were ameliorated by use of concomitant octreotide and 5-fluorouracil (P = 0.019, P = 0.023, P = 0.0001, P = 0.006, P = 0.0001, and P = 0.013, respectively). In addition, diarrhea was found to be prevented (P = 0.0001).

CONCLUSIONS

The results of this study showed that concomitant octreotide use might prevent the side effects of 5-fluorouracil, such as diarrhea, postoperative adhesion, and delaying the anastomotic healing parameters. In addition, it might reduce tissue damage and inflammation.

Effect of peritoneal lavage with taurolidine on primary colonic anastomosis in a rat model of secondary peritonitis

PURPOSE

The reported antibacterial, antiendotoxic, and antiadhesive effects of taurolidine prompted us to study the benefits of intraperitoneal lavage with taurolidine on primary colonic anastomosis in a rat model of secondary peritonitis.

METHODS

We induced peritonitis in 40 rats by injecting Escherichia coli isolate intraperitoneally. We performed colonic resection and primary anastomosis 5 h later, after lavage with either taurolidine or saline solution. After the rats were killed, on postoperative day (POD) 3 (n = 10) or 7 (n = 10), we measured the bursting pressures and hydroxyproline levels, then examined the resected specimens histologically.

RESULTS

Bursting pressures and tissue hydroxyproline levels were significantly higher in the taurolidine group than in the control group on PODs 3 and 7 (P < 0.05). Histopathological examination revealed significantly higher fibroblastic activity in the taurolidine group.

CONCLUSIONS

The higher bursting pressures and tissue hydroxyproline levels in the rats given taurolidine showed the positive effect of taurolidine on anastomotic strength in secondary peritonitis. Taurolidine is a novel antibiotic with both antibacterial and antiendotoxic effects. Intraperitoneal lavage with taurolidine solution may reduce the risks associated with performing primary colonic anastomosis in patients with secondary peritonitis.

Effects of high bilirubin levels on the healing of intestinal anastomosis

PURPOSE

This article analyzes the relationship between high biluribin levels and anastomotic healing in the long term.

METHODS

Ninety rats were randomly divided into six groups. The first three groups were jaundiced while the other three were unjaundiced. In the jaundiced groups, the rats' common bile ducts were ligated for 1, 2, and 3 weeks and ileal anastomosis was performed. In unjaundiced groups, only anastomosis was performed for 1, 2, and 3 weeks. At the end of the study, the values of the bursting pressures and hydroxyproline levels were determined in all groups. The bilirubin levels were also followed in jaundiced groups.

RESULTS

In the jaundiced groups, the mean hydroxyproline contents were 7.5 +/- 4.0, 6.3 +/- 2.3, and 5.6 +/- 2.1 (microHP/mg tissue) and the mean bursting pressures were 178 +/- 38, 171 +/- 23, and 164 +/- 26 mmHg at weeks 1, 2, and 3, respectively. In the unjaundiced groups, the mean hydroxyproline contents were 7.6 +/- 3.2, 8.1 +/- 3.0, and 8.6 +/- 2.5 (microHP/mg tissue) and the mean bursting pressures were 181 +/- 28, 183 +/- 21, and 186 +/- 22 mmHg at weeks 1, 2, and 3, respectively. The bilirubin levels were 3.8 +/- 1.5, 6.5 +/- 2.3, and 11.2 +/- 2.9 mg/dl at weeks 1, 2, and 3, respectively, in the jaundiced groups and 0.6 +/- 0.06, 0.6 +/- 0.03, and 0.7 +/- 0.04 mg/dl in the unjaundiced groups.

CONCLUSION

This study showed that the bilirubin levels can lead to a deterioration depending on the magnitude of the rise in the bilirubin levels.

Sustained local application of low-dose epidermal growth factor on steroid-inhibited colonic wound healing

BACKGROUND/PURPOSE

The effects of locally administered low-dose epidermal growth factor in a steroid-inhibited wound healing were investigated in a rat model.

METHODS

Long-acting release of epidermal growth factor was enabled using microspheres embedded in gelatin sponge. Study groups consisted of 60 rats with 10 in each: colonic anastomosis only (C), plus pure gelatin sponge (CG), plus epidermal growth factor loaded sponge (CE), colonic anastomosis and steroid (S), plus gelatine sponge (SG), and plus epidermal growth factor-loaded gelatine sponge (SE) groups. Bursting pressure and wound hydroxy-proline content were measured. Bursting sites were recorded. Collagen deposits, inflammation, and foreign body reactions were evaluated.

RESULTS

Bursting pressure and hydroxy-proline contents were found lowest in the S and highest in the CE groups (P <.01). There was almost no difference between C and SE groups. Bursts were encountered in peri-anastomotic normal colon sites in the nonsteroid-treated C, CG, and CE groups. They were noted overwhelmingly at the anastomosis in steroid-inhibited S, SG, and SE groups. Histopathology results showed a standstill at the inflammatory phase of healing in S and SG groups. The best healing was observed in the CE group. Degree of collagen accumulation was well correlated with bursting pressure and hydroxy-proline content data with a negligible foreign body reaction to gelatine sponge.

CONCLUSIONS

Continuous local epidermal growth factor administration by microspheres in gelatin increases wound collagen and further enhances healing in colonic anastomoses even with steroid inhibition.