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Luchtefeld M, Jrebi N, Hostetter G, Osterholzer K, Dykema K, Khoo SK. Effect of Doxycycline-Release Anastomotic Augmentation Ring on Porcine Colorectal Anastomosis. J Surg Res 2022; 279:464-473. [PMID: 35842971 DOI: 10.1016/j.jss.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/17/2022] [Accepted: 05/21/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Collagen degradation can lead to early postoperative weakness in colorectal anastomosis. Matrix metalloproteinase inhibitors (MMPIs) are shown to decrease collagen breakdown and enhance healing in anastomosis in animal models. Here, we evaluated the effectiveness of a novel anastomotic augmentation ring (AAR) that releases doxycycline, an MMPI, from a poly(lactic-co-glycolic) acid ring in porcine anastomoses. METHODS Two end-to-end stapled colorectal anastomoses were performed in 20 Yorkshire-Hampshire pigs. AAR was randomly incorporated into either the proximal or distal anastomosis as treatment, while nonaugmented anastomosis served as a control. Animals were then euthanized on days 3, 4, and 5 before anastomosis explantation and burst pressure measurement. Each anastomosis site was also collected for histology, hydroxyproline content, and gene expression microarray analyses. RESULTS No abscess or anastomotic leak was detected. Average burst pressures were not significantly different at any time point. There is no statistical difference in collagen content between the treatment group and controls. Gene expression analysis revealed no statistically significant in differentially expressed genes. However, genes related to inflammation, such as C-C motif chemokine ligand 11 (CCL11), CD70, and C-X-C motif chemokine ligand 10 (CXCL10), were upregulated (not statistically significant) in AAR compared to non-AAR anastomosis sites on days 3 and 4. CONCLUSIONS This pilot study shows that doxycycline-release AAR is feasible and safe. While burst pressure and collagen content did not change significantly with doxycycline treatment, upregulating genes related to the inflammatory process for pathogen and debris clearance in AAR may improve the early stage of colorectal anastomotic healing.
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Affiliation(s)
| | - Nezar Jrebi
- Spectrum Health, Grand Rapids, Michigan; North Texas Surgical Specialists, Fort Worth, Texas
| | - Galen Hostetter
- Pathology and Biorepository Core, Van Andel Institute, Grand Rapids, Michigan
| | | | | | - Sok Kean Khoo
- Department of Cell and Molecular Biology, Grand Valley State University, Allendale, Michigan.
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The science of anastomotic healing. SEMINARS IN COLON AND RECTAL SURGERY 2022; 33. [DOI: 10.1016/j.scrs.2022.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Gorur M, Sozutek A, Irkorucu O, Karakaya B. The influence of platelet-rich plasma (PRP) on colonic anastomosis healing impaired by intraperitoneal 5-flourouracil application. An experimental study. Acta Cir Bras 2020; 35:e202000504. [PMID: 32638844 PMCID: PMC7341987 DOI: 10.1590/s0102-865020200050000004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/22/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose 5-flourourasil (5-FU) is commonly used for early intraperitoneal chemotherapy in colorectal or appendiceal cancer patients with peritoneal carcinomatosis. Due to its effect, anastomosis healing can be impaired and leads to anastomotic leakage. In this study, we aimed to investigate the potential healing effect of platelet-rich plasma (PRP) on colonic anastomosis impaired by intraperitoneal 5-flourouracil application. Methods After ten rats were sacrificed for preparing PRP, forty Wistar-albino rats were subjected to colonic anastomosis, and randomly allocated into four groups including 10 rats each. According to receiving PRP and/or 5-FU application, the groups were formed as control (C), 5-FU without PRP (CT), anastomosis with PRP (C-PRP), and 5-FU with PRP (CT-PRP). CT and CT-PRP groups also received 5-FU intraperitoneally on postoperative day 1 (POD 1). All animals were euthanized on pod 7. The body weight change, anastomotic bursting pressure (ABP), tissue hydroxiprolin (TH) and histopathological examination of each group were analyzed. Results 5-FU application significantly reduced ABP levels when compared with group C, C-PRP and CT-PRP (for each comparison, p<0,01). PRP application in CT-PRP group raised the measure of ABP up to the levels of C group. Although tissue hydroxyproline levels (THL) levels of CT-PRP group were found higher than CT group, it was not significant (p=0.112). Microscopically, comparing with CT group, PRP application significantly promoted the healing of colonic anastomosis subjected to 5-FU application by improving tissue edema, necrosis, submucosal bridging and collagen formation (p<0.05). Tissue healing in CT-PRP group was observed as good as the control groups. (C, C-PRP, p=0.181, p=0.134; respectively). Conclusion PRP administration on colonic anastomosis significantly promotes the healing process of anastomosis in rats receiving 5-FU. This result encourages further clinical use of PRP to reduce the frequency of AL in patients receiving EPIC.
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Seifert GJ, Leithold G, Kulemann B, Holzner PA, Glatz T, Hoeppner J, Kirste S, Marjanovic G, Laessle C. The effect of pasireotide on intestinal anastomotic healing with and without whole-body irradiation in a rat model. Int J Colorectal Dis 2019; 34:337-345. [PMID: 30483864 PMCID: PMC6331742 DOI: 10.1007/s00384-018-3193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To examine pasireotide's effect on intestinal anastomotic healing under physiological conditions and following preoperative whole-body irradiation. MATERIAL AND METHODS Forty-five male Wistar rats received an ileoileal end-to-end anastomosis. Group 1 (Co, n = 9) served as control. Group 2 (SOM, n = 10) received pasireotide (60 mg/kg) 6 days preoperatively. Group 3 (R-Co, n = 13) was subjected to 8 Gy whole-body irradiation 4 days preoperatively. Finally, group 4 (R-SOM, n = 13) received pasireotide 6 days preoperatively and whole-body irradiation 4 days preoperatively. On postoperative day 4, anastomotic bursting pressure, histology, IGF-1 staining, and collagen density were examined. RESULTS Mortality was higher in irradiated animals (30.8% vs. 5.3%, p = 0.021), and anastomotic bursting pressure was significantly lower (median, R-Co = 83 mmHg; R-SOM = 101 mmHg; Co = 149.5 mmHg; SOM = 169 mmHg). Inflammation measured by leukocyte infiltration following irradiation was reduced (p = 0.023), and less collagen was observed, though this was not statistically significant. Bursting pressure did not significantly differ between Co and SOM and between R-Co and R-SOM animals respectively. Semi-quantitative scoring of IGF-1, fibroblast bridging, or collagen density did not reveal significant differences among the groups. CONCLUSION Whole-body irradiation decreases the quality of intestinal anastomotic wound healing and increases mortality. Pasireotide does not significantly lessen this detrimental effect.
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Affiliation(s)
- Gabriel J Seifert
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
| | - Gunnar Leithold
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Birte Kulemann
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Philipp A Holzner
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Torben Glatz
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Jens Hoeppner
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Simon Kirste
- Department of Radiooncology, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Goran Marjanovic
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Claudia Laessle
- Department of General and Visceral Surgery, Medical Centre - University of Freiburg, Faculty of Medicine, University Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
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Effects of teduglutide on histological parameters of intestinal anastomotic healing. Eur Surg 2017. [DOI: 10.1007/s10353-017-0478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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: 14] [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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The effects of hyperbaric oxygen therapy on experimental colon anastomosis after preoperative chemoradiotherapy. Int Surg 2014; 98:33-42. [PMID: 23438274 DOI: 10.9738/cc130.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female Wistar-Albino rats were divided into 5 groups and underwent left colon resection and end-to-end anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.
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Sabino FD, Campos CFF, Caetano CER, Trotte MNS, Oliveira AV, Marques RG. Effects of TachoSil and 5-fluorouracil on colonic anastomotic healing. J Surg Res 2014; 192:375-82. [PMID: 24976442 DOI: 10.1016/j.jss.2014.05.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/16/2014] [Accepted: 05/21/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND The administration of intraperitoneal (IP) 5-fluorouracil (5-FU) during the early postoperative period after cytoreductive surgery can decrease local cancer recurrence but may also cause impairment of the anastomotic healing. This study examined the effects of the use of this therapy and of the anastomotic sealing with TachoSil, a fibrin-thrombin coated sealant (FTCS), on the healing of colon anastomoses. MATERIALS AND METHODS Forty male rats were divided into four groups (1-4, 10 rats each) that underwent transection and anastomosis of the left colon. The anastomoses were covered with FTCS in groups 2 and 4. Saline solution (2 mL/d-groups 1 and 2) or 5-FU (20 mg/kg/d; groups 3 and 4) was administered IP once daily for 3 d. Bursting pressure (BP) was recorded, and the anastomoses were examined macroscopically and graded histologically. RESULTS The relative weight loss was significantly higher in group 3 than in the other groups (P = 0.0004). Anastomotic dehiscence, postoperative adhesion formation, perianastomotic collections, and preanastomotic dilatation did not differ significantly among groups. BP was significantly lower in group 3 compared with all other groups (P = 0.001). Neoangiogenesis was significantly lower in group 3 compared with groups 1 and 2 (P = 0.05). Fibroblastic activity was significantly higher in group 1 compared with group 3 (P = 0.035). Inflammatory cell infiltration and collagen deposition did not differ significantly among groups. CONCLUSIONS Our results shown that the early postoperative IP chemotherapy with 5-FU impaired the healing of colon anastomoses. However, anastomotic sealing with FTCS reversed some of the negative effects of this therapy.
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Affiliation(s)
- Flávio D Sabino
- Department of Abdominal and Pelvic Surgery, National Cancer Institute, Rio de Janeiro, Brazil; Department of General Surgery, Federal Hospital of Rio de Janeiro State Civil Servers, Rio de Janeiro, Brazil.
| | | | - Carlos Eduardo R Caetano
- Department of General Surgery, Laboratory of Experimental Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Marcele Nogueira S Trotte
- Department of General Surgery, Laboratory of Experimental Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Albanita V Oliveira
- Department of Pathology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ruy G Marques
- Department of General Surgery, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Li ZJ, Ying XJ, Chen HL, Ye PJ, Chen ZL, Li G, Jiang HF, Liu J, Zhou SZ. Insulin-like growth factor-1 induces lymphangiogenesis and facilitates lymphatic metastasis in colorectal cancer. World J Gastroenterol 2013; 19:7788-7794. [PMID: 24282367 PMCID: PMC3837280 DOI: 10.3748/wjg.v19.i43.7788] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/29/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the expression of insulin-like growth factor-1 (IGF-1)/insulin-like growth factor-1 receptor (IGF-1R) in colorectal cancer (CRC) tissues and to analyze their correlation with lymphangiogenesis and lymphatic metastasis.
METHODS: Immunohistochemistry was used to evaluate IGF-1 and IGF-1R expression and lymphatic vessel density (LVD) in 40 CRC specimens. The correlation between IGF-1/IGF-1R and LVD was investigated. Effects of IGF-1 on migration and invasion of CRC cells were examined using transwell chamber assays. A LoVo cell xenograft model was established to further detect the role of IGF-1 in CRC lymphangiogenesis in vivo.
RESULTS: Elevated IGF-1 and IGF-1R expression in CRC tissues was correlated with lymph node metastasis (r = 0.715 and 0.569, respectively, P < 0.05) and tumor TNM stage (r = 0.731 and 0.609, P < 0.05). A higher LVD was also found in CRC tissues and was correlated with lymphatic metastasis (r = 0.405, P < 0.05). A positive correlation was found between LVD and IGF-1R expression (r = 0.437, P < 0.05). Transwell assays revealed that IGF-1 increased the migration and invasion of CRC cells. In vivo mouse studies showed that IGF-1 also increased LVD in LoVo cell xenografts.
CONCLUSION: IGF-1/IGF-1R signaling induces tumor-associated lymphangiogenesis and contributes to lymphatic metastasis of CRC.
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Rijcken E, Sachs L, Fuchs T, Spiegel HU, Neumann PA. Growth factors and gastrointestinal anastomotic healing. J Surg Res 2013; 187:202-10. [PMID: 24290527 DOI: 10.1016/j.jss.2013.10.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 09/16/2013] [Accepted: 10/08/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Failure of anastomotic healing in the gastrointestinal tract is a major source of surgery-related morbidity, repeated surgical procedures, and impaired quality of life. Growth factors have been shown to be involved in healing processes in various tissues including the gastrointestinal tract. This opens the perspective to use growth factors therapeutically to support impaired anastomotic healing. The aim of the present study was to review the particular role of several growth factors in different phases of anastomotic healing, experimental approaches of growth factor application, and to discuss possibilities and limitations of growth factor-directed interventions in gastrointestinal surgery. MATERIALS AND METHODS A PubMed search was performed to examine the potential role of fibroblast growth factor, epidermal growth factor, heparin binding EGF-like growth factor, transforming growth factor β, insulin-like growth factor I, vascular endothelial growth factor, and platelet-derived growth factor during anastomotic healing. RESULTS Growth factors show beneficial effects on a broad range of cell types and regulate various processes during all phases of tissue healing. Despite extensive research in the field of growth factors, additional evidence is needed before translating into a clinical setting. CONCLUSIONS Future research should focus on adequate sustained but limited drug delivery. Undesired side effects, such as formation of strictures, development of peritoneal adhesions, and potential induction of malignancies, have to be reflected. Although growth factor application is currently far from clinical routine in gastrointestinal surgery, it might find application in selected patients at risk for impaired anastomotic healing, such as patients with long-time steroid therapy, immunosuppressives, inflammatory disorders, sepsis, hemodynamic shock, malnutrition, or neoadjuvant radiochemotherapy.
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Affiliation(s)
- Emile Rijcken
- Department of General and Visceral Surgery, Muenster University Hospital, Germany; Department of Surgical Research, Muenster University Hospital, Germany.
| | - Larissa Sachs
- Department of General and Visceral Surgery, Muenster University Hospital, Germany; Department of Surgical Research, Muenster University Hospital, Germany
| | - Thomas Fuchs
- Department of Surgical Research, Muenster University Hospital, Germany; Department of Trauma, Hand and Reconstructive Surgery, Muenster University Hospital, Germany
| | | | - Philipp-Alexander Neumann
- Department of General and Visceral Surgery, Muenster University Hospital, Germany; Department of Surgical Research, Muenster University Hospital, Germany
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Pramateftakis MG, Kanellos D, Mantzoros I, Despoudi K, Raptis D, Angelopoulos S, Koliakos G, Zaraboukas T, Lazaridis C. Intraperitoneally administered irinotecan with 5-fluorouracil impair wound healing of colonic anastomoses in a rat model: an experimental study. Tech Coloproctol 2012; 15 Suppl 1:S121-5. [PMID: 21887556 DOI: 10.1007/s10151-011-0755-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM The aim of this experimental study is the assessment of the effects of the immediate post-operative intraperitoneal administration of 5-fluorouracil and irinotecan on the healing process of large bowel anastomoses in rats. MATERIALS AND METHODS Sixty male Wistar rats were divided into 4 groups of 15 rats each. The rats underwent large bowel resection and anastomosis, followed by the intraperitoneal administration of normal saline (group 1), 5-fluorouracil (group 2), irinotecan (group 3) or the combination of 5-fluorouracil and irinotecan (group 4). All animals were killed on the eighth post-operative day. During post-mortem examination, the anastomoses were assessed macroscopically for a possible anastomotic leak and the extent of adhesion formation. Subsequently, the anastomotic bursting pressure was measured, and the anastomoses were assessed histologically. RESULTS No anastomotic dehiscence was observed in the rats of group 1. In groups 2 and 3, we observed 3 anastomotic leaks in each group, and in group 4, we observed 5 leaks (P = 0.111). The mean bursting pressure of the anastomoses in group 1 was significantly higher compared to groups 2, 3 and 4 (P < 0.001). The least inflammatory cell infiltration score was observed in group 1 (P < 0.001). The lowest neoangiogenesis score was observed in group 2 and the highest in group 4. The collagen formation in group 1 was significantly higher compared to the other 3 groups (P < 0.001). Similar results were observed for the fibroblast activity, where group 1 revealed significantly higher fibroblast scores compared to groups 2, 3 and 4 (P < 0.001). Finally, groups 2, 3 and 4 showed significantly lower hydroxyproline levels compared to the control group (P < 0.001). CONCLUSION The immediate, post-operative intraperitoneal administration of 5-fluorouracil or irinotecan had a negative effect on the healing process of the large bowel anastomoses in rats. The negative effects of the combination of 5-fluorouracil and irinotecan were statistically more significant compared to the single use of 5-fluorouracil or irinotecan.
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Affiliation(s)
- M G Pramateftakis
- 4th Surgical Department, Aristotle University of Thessaloniki, G Papanikolaou General Hospital, 57010 Exohi, Thessaloniki, Greece.
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In Vitro and In Vivo Evaluation of a Folate-Targeted Copolymeric Submicrohydrogel Based on N-Isopropylacrylamide as 5-Fluorouracil Delivery System. Polymers (Basel) 2011. [DOI: 10.3390/polym3031107] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Netta S, Michalopoulos A, Apostolidis S, Paramythiotis D, Papavramidis T, Papadopoulos V, Tziris N. Enhancement of colonic anastomotic strength in rats by short-chain fatty acids. Tech Coloproctol 2011; 14 Suppl 1:S53-5. [PMID: 20683753 DOI: 10.1007/s10151-010-0611-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The present study is aiming at elucidating the effect of intraoperative lavage with short-chain fatty acids (SCFAs) on colonic anastomosis in rats. METHODS Forty male Wistar rats were randomized into four groups (10 rats each). After resection of a segment of transverse colon, an end-to-end anastomosis was performed. In the 1st group, no intraoperative large bowel lavage was performed; in the 2nd, a lavage with normal saline solution; in the 3rd, the animals received a diet rich in SCFAs pre- and postoperatively, and a lavage with normal saline was performed; and in the 4th group, an intraoperative lavage with SCFAs was carried out. On the 4th postoperative day, the animals were sacrificed. Septic complications, adhesions and anastomoses were graded macroscopically and histologically, and bursting pressure of the anastomoses, CRP, IL-6 and TNF-a was measured. RESULTS Fewer septic complications (abscesses and minimal ruptures) and adhesions were observed in the 4th group with the intraoperative lavage with SCFAs. The bursting pressure also, in the same group, was higher (73.3 mmHg), followed by the 1st group (67.1 mmHg). CONCLUSION Intraoperative lavage with SCFAs increases the bursting pressure of colonic anastomoses, while lavage with saline solution decreases it, in comparison to the group without lavage.
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Affiliation(s)
- S Netta
- 1st Propedeutic Surgical Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, T.Ikonimidi 21, 551 31 Kalamaria, Thessaloniki, Greece
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Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing. Int J Colorectal Dis 2010; 25:223-32. [PMID: 19865820 DOI: 10.1007/s00384-009-0833-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2009] [Indexed: 02/06/2023]
Abstract
PURPOSE This study investigated whether covering the colonic anastomoses with amniotic membrane (AM) protects the anastomotic healing from the adverse effects of immediate 5-fluorouracil (5-FU) administration. METHODS One hundred twenty wistar albino rats were randomized to one of four groups (I-IV, 30 rats in each) and underwent a standardized left colon resection and anastomoses. The anastomoses of the rats in groups II (AM) and IV (5-FU + AM) were covered with AM. Saline solution (2 ml/day; groups I (control) and II) or 5-FU (20 mg/kg/day; groups III (5-FU) and IV) was administered to the rats intraperitoneally once daily from the day of operation until sacrificed. Half of each group was sacrificed on the postoperative day 4 (IA, IIA, IIIA, and IVA) and other half on the postoperative day 8 (IB, IIB, IIIB, and IVB), and their anastomoses were evaluated when sacrificed. RESULTS The dehiscence rate of anastomotic dehiscence and adhesion formation were significantly higher in groups IIIA and IIIB compared with groups IVA and IVB, respectively. Bursting pressure was significantly higher in the 5-FU + AM groups than in the 5-FU groups. The inflammatory cell infiltration was significantly lower in groups IIIA and IVA compared with group IA, in groups IIIB and IVB compared with group IB, and in group IVA compared with group IIIA. Neoangiogenesis, fibroblast activity, collagen deposition, and hydroxyproline levels were significantly higher in the 5FU + AM groups compared with control and 5-FU groups. Malondialdehyde levels were significantly higher in the 5-FU groups than in the 5-FU + AM groups. CONCLUSION Covering colon anastomoses with AM protects them, preventing leakage and reversing the negative effects of 5-FU administration.
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