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Bessard A, Cardaillac C, Oullier T, Cenac N, Rolli-Derkinderen M, Neunlist M, Venara A. Alterations of Prostanoid Expression and Intestinal Epithelial Barrier Functions in Ileus. J Surg Res 2024; 296:165-173. [PMID: 38277953 DOI: 10.1016/j.jss.2023.12.018] [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: 07/12/2023] [Revised: 11/27/2023] [Accepted: 12/23/2023] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Intestinal manipulation (IM)-induced inflammation could contribute to postoperative ileus (POI) pathophysiology via the modulation of prostanoid pathways. To identify the prostanoids involved, we aimed to characterize the profile of prostanoids and their synthesis enzyme expression in a murine model of POI and to determine whether the altered prostanoids could contribute to POI. METHODS Four or 14 h after IM in mice, gastrointestinal (GI) motility and intestinal epithelial barrier (IEB) permeability were assessed in vivo and ex vivo in Ussing chambers. Using high sensitivity liquid chromatography-tandem mass spectrometry, we characterized the tissue profile of polyunsaturated fatty acid metabolites in our experimental model. Finally, we evaluated in vivo the effects of the prostanoids studied upon IM-induced gut dysfunctions. RESULTS We first showed that 14 h after IM was significantly faster than jejunal transit at 4 h post-IM, although it remained significantly increased compared to the control. In contrast, we showed that IM-induced inflammation increase in jejunum permeability was similar after four and 14 h. We next showed that expression of prostacyclin synthase and hemopoietic prostaglandin-D synthase mRNA and their products were significantly reduced 14 h after IM as compared to controls. Furthermore, 15-deoxy-delta 12,14-Prostaglandin J2 reduced the IM-induced inflammation increase in IEB permeability but had no effect on GI motility. In contrast, PGI2 increased IM-induced IEB permeability and motility dysfunctions. CONCLUSIONS Arachidonic acid derivative contributes differentially to GI dysfunction in POI. The decrease of 15-deoxy-delta 12,14-Prostaglandin J2 levels induced by IM could contribute to impaired GI dysfunctions in POI and could be considered as putative therapeutic targets to restore barrier dysfunctions associated with POI.
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Affiliation(s)
- Anne Bessard
- CHU Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes Université, Nantes, France
| | - Claire Cardaillac
- CHU Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes Université, Nantes, France; Department of Gynaecology and Obstetrics, University Hospital of Nantes, Nantes, France
| | - Thibauld Oullier
- CHU Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes Université, Nantes, France
| | - Nicolas Cenac
- IRSD, INSERM, INRAe, ENVT, UPS, Université de Toulouse-Paul Sabatier, Toulouse, France
| | - Malvyne Rolli-Derkinderen
- CHU Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes Université, Nantes, France
| | - Michel Neunlist
- CHU Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes Université, Nantes, France
| | - Aurélien Venara
- CHU Nantes, INSERM, The Enteric Nervous System in Gut and Brain Disorders, IMAD, Nantes Université, Nantes, France; Department of Visceral and Endocrinal Surgery, University Hospital of Angers, Angers, France; IHFIH, UPRES EA 3859, University of Angers, Angers, France.
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Koşar MN, Görgülü Ö. Incidence and mortality results of intestinal obstruction in geriatric and adult patients: 10 years retrospective analysis. Turk J Surg 2021; 37:363-370. [PMID: 35677479 PMCID: PMC9130947 DOI: 10.47717/turkjsurg.2021.5177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
Objectives People with ileus is one of the patient groups with the highest admission rates to the emergency departments. In this study, it was aimed to determine the effects of age groups and etiological factors on mortality when evaluated together with gender. Material and Methods In our study, patients who were consulted from the Emergency Service to the General Surgery department with a pre-diagno- sis of abdominal pain between 2009 and 2020 were retrospectively screened. Patients hospitalized for ileus were analyzed in terms of age (18-65 years and over 65 years), gender, operation, etiology, incidence, and mortality. Results Between 2009 and 2020, 534 (3.03%) of 17.601 patients who received emergency consultation from the general surgery clinic were diagnosed with ileus. While 253 (47.4%) of the patients were operated, 317 (59.4%) patients and 101 (18.9%) patients were diagnosed with brid and malignancy, respectively; and 21 (3.9%) patients died in the complete patient group (Table 1). While the incidence of brid was high in non-operated patients, in operated patients, malignancy and other pathologies was found to be higher (p <0.001) (Table 2). While, in patients 65 years and older, mortality was observed in 10.6% of women and 2.6% of men, it was determined that the mortality rate was higher in women (p= 0.008) (Figure 4). Conclusion The mortality rate in patients hospitalized with the diagnosis of mechanical bowel obstruction was found to be statistically significantly higher in female patients aged 65 and over.
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Affiliation(s)
- Mehmet Nuri Koşar
- Clinic of General Surgery, University of Health Science Antalya Training and Research Hospital, Antalya, Turkey
| | - Özkan Görgülü
- Clinic of Anesthesia and Reanimation, University of Health Science Antalya Training and Research Hospital, Antalya, Turkey
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Lee L, Fiore JF. NSAIDs and anastomotic leak: What's the evidence? SEMINARS IN COLON AND RECTAL SURGERY 2021. [DOI: 10.1016/j.scrs.2021.100833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Toh JWT, Cecire J, Hitos K, Shedden K, Gavegan F, Pathmanathan N, El Khoury T, Di Re A, Cocco A, Limmer A, Liang T, Fok KY, Rogers J, Solis E, Ctercteko G. The impact of variations in care and complications within a colorectal enhanced recovery after surgery (ERAS) program on length of stay. Ann Coloproctol 2021:ac.2020.11.23. [PMID: 33957036 PMCID: PMC8898630 DOI: 10.3393/ac.2020.11.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose Enhanced Recovery After Surgery (ERAS) has become standard of care in colorectal surgery. However, there is not a universally accepted colorectal ERAS protocol and significant variations in care exist between institutions. The aim of this study was to examine the impact of variations in ERAS interventions and complications on length of stay (LOS). Methods This study was a single-center review of the first 200 consecutive patients recruited into our prospectively collected ERAS database. The primary outcome of this study was to examine the rate of compliance to ERAS interventions and the impact of these interventions on LOS. The secondary outcome was to assess the impact of complications (anastomotic leak, ileus, and surgical site infections) on LOS. ERAS interventions, rate of adherence, LOS, readmissions, morbidity, and mortality were recorded, and statistical analysis was performed. Results ERAS variations and complications significantly influenced patient LOS on both univariate and multivariate analysis. ERAS interventions identified as the most important strategies in reducing LOS included laparoscopic surgery, mobilization twice daily postoperative day (POD) 0 to 1, discontinuation of intravenous fluids on POD 0 to 1, upgrading to solid diet by POD 0 to 2, removal of indwelling catheter by POD 0 to 2, avoiding nasogastric tube reinsertion and removing drains early. Both major and minor complications increased LOS. Anastomotic leak and ileus were associated with the greatest increase in LOS. Conclusion Seven high-yield ERAS interventions reduced LOS. Major and minor complications increased LOS. Reducing variations in care and complications can improve outcomes following colorectal surgery.
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Affiliation(s)
- James Wei Tatt Toh
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia.,University of New South Wales, Sydney, Australia
| | - Jack Cecire
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Kerry Hitos
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.,Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Sydney, Australia
| | - Karen Shedden
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Fiona Gavegan
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Nimalan Pathmanathan
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Toufic El Khoury
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia.,University of Notre Dame Australia, Sydney, Australia
| | - Angelina Di Re
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Annelise Cocco
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Alex Limmer
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Tom Liang
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Kar Yin Fok
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - James Rogers
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Edgardo Solis
- Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
| | - Grahame Ctercteko
- Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, Australia.,Department of Surgery, Westmead Hospital, Cnr Hawkesbury and Darcy Rd, Westmead, NSW 2145, Australia
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Meunier A, Sorce G, Hardy PY, Coimbra C, Decker E, Joris J. Comparison of outcome after right colectomy with an enhanced recovery programme in patients with inflammatory bowel disease and patients operated on for other conditions: a monocentric retrospective study. Int J Colorectal Dis 2021; 36:757-763. [PMID: 33423143 DOI: 10.1007/s00384-020-03830-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Enhanced recovery programmes (ERPs) after surgery reduce postoperative complications and hospital stay. Patients with inflammatory bowel disease (IBD) often present risk factors for postoperative complications. This accounts for reluctance to include them in ERPs. We compared outcome after right colectomy with an ERP in IBD and non-IBD patients. METHODS In our GRACE colorectal surgery database comprising 508 patients, we analysed patients scheduled for right colectomy (n = 160). Adherence to the protocol, postoperative complications and length of hospital stay of IBD patients (n = 45) were compared with those of non-IBD patients (n = 115). Data (mean ± SD, median [IQR], count (%)) were compared by Student's t, Mann-Whitney U and chi-square tests when appropriate; p < 0.05 taken as statistically significant. RESULTS IBD patients were significantly younger (38.9 ± 13.8 vs. 58.9 ± 18.5 years, p < 0.001) and had lower BMI (23.0 ± 5.0 vs. 25.1 ± 5.0 kg m-2, p < 0.01). Adherence to ERP was similar in the two groups. Resumption of eating on the day of the operation was less well tolerated (73.3% vs. 85.2%, p < 0.05) and postoperative pain (p < 0.001) was greater in IBD patients. The incidence of postoperative complications (13.3% vs. 17.3%) and the length of hospital stay (3 [3-4.5] vs. 3 [2-5] days) were comparable in IBD and non-IBD patients, respectively. CONCLUSION The management of IBD patients in an ERP is not only feasible but also indicated. These patients benefit as much from ERP as non-IBD patients.
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Affiliation(s)
- Anne Meunier
- Department of Anaesthesiology and Reanimation, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, avenue de l'hôpital Bat B35, B-4000, Liège, Belgium
| | - Giuseppe Sorce
- Service of Abdominal Surgery, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, Liège, Belgium
| | - Pierre-Yves Hardy
- Department of Anaesthesiology and Reanimation, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, avenue de l'hôpital Bat B35, B-4000, Liège, Belgium
| | - Carla Coimbra
- Service of Abdominal Surgery, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, Liège, Belgium
| | - Emmanuel Decker
- Service of Abdominal Surgery, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, Liège, Belgium
| | - Jean Joris
- Department of Anaesthesiology and Reanimation, CHU Liège, University of Liège, Domaine universitaire du Sart Tilman, avenue de l'hôpital Bat B35, B-4000, Liège, Belgium. .,Groupe francophone de réhabilitation améliorée après chirurgie (GRACE; Francophone group for enhanced recovery after surgery, www.grace-asso.fr), Beaumont, France.
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Elderly patients over 70 years benefit from enhanced recovery programme after colorectal surgery as much as younger patients. J Visc Surg 2020; 157:23-31. [DOI: 10.1016/j.jviscsurg.2019.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Purnomo E, Nugrahaningsih DAA, Agustriani N, Gunadi. Comparison of metamizole and paracetamol effects on colonic anastomosis and fibroblast activities in Wistar rats. BMC Pharmacol Toxicol 2020; 21:6. [PMID: 31931882 PMCID: PMC6958591 DOI: 10.1186/s40360-020-0383-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leakage following colorectal anastomosis surgery causes various complications associated with high morbidity and mortality, especially in pediatric patients. It might be caused by the use of non-steroidal anti-inflammatory drugs (NSAIDs) as postoperative analgesics. This study aimed to compare the effect of metamizole and paracetamol on colonic anastomosis and fibroblast activities, including proliferation, migration, and collagen synthesis, in Wistar rats. METHODS Rats were divided into control, paracetamol and metamizole groups. The colonic anastomosis was evaluated by determining the integrity of the muscle layers, the formation of granulation tissue, and mucosal anastomosis. Fibroblast activities were analyzed by measuring the proliferation, migration, and collagen synthesis. RESULTS Metamizole caused more damage to muscle layer integrity, more inhibition of granulation tissue formation in the anastomosis area and lower mucosal anastomosis compared with paracetamol and control groups. Metamizole had a higher cytotoxic effect than paracetamol, which suppressed the proliferation and migration of fibroblasts. Furthermore, both drugs did not affect the synthesis of collagen. CONCLUSION Metamizole shows worse effects on the integrity of muscle layers, inhibition of granulation tissue formation, mucosal anastomosis, fibroblast proliferation, and migration, but not collagen synthesis, than paracetamol in Wistar rat intestines following colonic anastomosis. These findings might indicate that paracetamol is safer than metamizole as analgesic following colonic anastomosis.
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Affiliation(s)
- Eko Purnomo
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/UGM Academic Hospital, Yogyakarta, 55291, Indonesia
| | - Dwi Aris Agung Nugrahaningsih
- Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.
| | - Nunik Agustriani
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, 55281, Indonesia
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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: 0.8] [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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The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy. World J Surg 2019; 43:1746-1755. [DOI: 10.1007/s00268-019-04938-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Beloeil H, Slim K. Sustainability of anaesthesia components of an enhanced recovery program (ERP) in colorectal and orthopaedics surgery. Anaesth Crit Care Pain Med 2019; 38:25-28. [DOI: 10.1016/j.accpm.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/29/2022]
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Abstract
Postoperative ileus (POI) is a major focus of concern for surgeons because it increases duration of hospitalization, cost of care, and postoperative morbidity. The definition of POI is relatively consensual albeit with a variable definition of interval to resolution ranging from 2 to 7 days for different authors. This variation, however, leads to non-reproducibility of studies and difficulties in interpreting the results. Certain risk factors for POI, such as male gender, advanced age and major blood loss, have been repeatedly described in the literature. Understanding of the pathophysiology of POI has helped combat and prevent its occurrence. But despite preventive and therapeutic efforts arising from such knowledge, 10 to 30% of patients still develop POI after abdominal surgery. In France, pharmacological prevention is limited by the unavailability of effective drugs. Perioperative nutrition is very important, as well as limitation of preoperative fasting to 6 hours for solid food and 2 hours for liquids, and virtually no fasting in the postoperative period. Coffee and chewing gum also play a preventive role for POI. The advent of laparoscopy has led to a significant improvement in the recovery of gastrointestinal function. Enhanced recovery programs, grouping together all measures for prevention or cure of POI by addressing the mechanisms of POI, has reduced the duration of hospitalization, morbidity and interval to resumption of transit.
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