1
|
Makanyengo SO, Carroll GM, Goggins BJ, Smith SR, Pockney PG, Keely S. Systematic Review on the Influence of Tissue Oxygenation on Gut Microbiota and Anastomotic Healing. J Surg Res 2020; 249:186-196. [PMID: 31986361 DOI: 10.1016/j.jss.2019.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/04/2019] [Accepted: 12/06/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anastomotic leak rates have not improved over several decades despite improvements in surgical techniques and patient care. The gut microbiome has been implicated in the development of leaks. The exact mechanisms by which tissue oxygenation affects gut microbial composition and anastomotic healing physiology are unclear. Also, commonly used carbon dioxide (CO2) is a known vasodilator that improves tissue oxygen tension. We performed a systematic review to determine the influence of hyperoxia, hypoxia, and hypercapnia on the gut microbiome and anastomotic healing. METHODS A literature search was performed in MEDLINE, EMBASE, and COCHRANE to identify studies investigating the effects of hyperoxia, hypoxia, and hypercapnia on anastomotic healing and gut microbiota published between 1998 and 2018. Two reviewers screened the articles for eligibility and quality. Fifty-three articles underwent full text review, and a narrative synthesis was undertaken. RESULTS Hyperoxia is associated with better anastomotic healing, increased gastrointestinal oxygen tension, and may reduce gut anaerobes. Hypoxia is associated with poor healing and increased gut anaerobes. However, it is unclear if hypoxia is the most important predictor of anastomotic leaks. Low pressure CO2 pneumoperitoneum and mild systemic hypercapnia are both associated with increased gastrointestinal oxygen tension and may improve anastomotic healing. We found no studies which investigated the effect of hypercapnia on gut microbiota in the context of anastomotic healing. CONCLUSIONS Tissue oxygenation influences gut anastomotic healing, but little evidence exists to demonstrate the influence on the gut microbiome in the context of healing. Further studies are needed to determine if anastomotic microbiome changes with altered tissue oxygenation and if this affects healing and leak rates. If confirmed, altering tissue oxygenation through hyperoxia or hypercapnia could be feasible means of altering the microbiome such that anastomotic leak rates reduce.
Collapse
Affiliation(s)
- Samwel O Makanyengo
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia.
| | - Georgia M Carroll
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Bridie J Goggins
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Stephen R Smith
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Peter G Pockney
- Department of Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Simon Keely
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| |
Collapse
|
2
|
Brouwer RJ, Engberts AC, Borger van der Burg BL, van Dongen TT, van Hulst RA, Hoencamp R. Meta-analysis on the effect of hyperbaric oxygen as adjunctive therapy in the outcome of anastomotic healing of experimental colorectal resections in rats. Diving Hyperb Med 2019; 48:173-185. [PMID: 30199890 DOI: 10.28920/dhm48.3.173-185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Colorectal cancer is the third most common form of cancer and colorectal surgery is the treatment of choice in local disease. Anastomotic leakage following colorectal surgery is a major complication with a high incidence and mortality. Adjuvant hyperbaric oxygen treatment (HBOT) may be associated with reduction of anastomotic leakage. A systematic review was conducted regarding HBOT as an adjunctive therapy to colorectal surgery. METHODS Systematic review (1900-2017) using PubMed, Cochrane, EMBASE, Web of Science and EMCARE. All original published studies on the effect of HBOT as an adjunctive therapy for colorectal surgery with the creation of an anastomosis were considered. RESULTS Thirteen small animal trials were included for qualitative synthesis. We found no human trials. Eleven trials used bursting pressure whilst eight used hydroxyproline levels as a marker for collagen synthesis as primary outcome to assess the strength of the anastomosis. A meta-analysis performed for normal and ischaemic anastomoses showed that postoperative HBOT improves bursting pressure and hydroxyproline levels significantly in both normal (p ≤ 0.001 and p = 0.02) and ischaemic anastomoses (p ≤ 0.001 and p = 0.04). CONCLUSION Postoperative HBOT has a positive effect on colorectal anastomoses in rats. Further research should focus on a larger systematic animal study.
Collapse
Affiliation(s)
- Robin J Brouwer
- Corresponding author: Department of Surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands,
| | | | | | - Thijs Tcf van Dongen
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.,Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands
| | - Rob A van Hulst
- Department of Anesthesiology, Amsterdam Medical Center, Amsterdam, The Netherlands.,Maritime Medical Expertise Center, Diving Medical Center, Royal Netherlands Navy, Den Helder, The Netherlands
| | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands.,Defense Healthcare Organization, Ministry of Defense, Utrecht, The Netherlands.,Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
3
|
Stergios K, Kontzoglou K, Pergialiotis V, Korou LM, Frountzas M, Lalude O, Nikiteas N, Perrea DN. The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes. Ann R Coll Surg Engl 2017; 99:189-192. [PMID: 27917665 PMCID: PMC5450286 DOI: 10.1308/rcsann.2016.0357] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 12/25/2022] Open
Abstract
Colorectal anastomoses continuous to pose a significant challenge in current surgical practice. Anastomotic leakage remains one of the most frequent and dramatic complications of colorectal surgery, even in centres of high specialisation. Diabetes is a well-established independent factor which results in higher anastomotic leakage rates. Fibrin sealants have been applied in experimental and clinical studies for the prevention of anastomotic dehiscence. However, little is known regarding their impact on diabetic patients. Several fibrin sealants have been proposed as adjunct to standard surgical techniques to prevent leakage from colonic anastomoses following the reversal of temporary colostomies, approved for general haemostasis. This review summarises current advances in colorectal anastomoses and provides evidence that may strengthen the need for tissue sealants in colorectal anastomoses of diabetic patients. We searched Medline (1966-2016) and Scopus (2004-2016) for current evidence in the field. To date, there is no evidence to support the use of fibrin sealants as an adjunct in diabetic patients who undergo colorectal surgery. Experimental animal models with extreme diabetes could be of significant use in the present field and further research is needed prior to application of fibrin sealants in a clinical setting.
Collapse
Affiliation(s)
- K Stergios
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
- Colorectal Department, General Surgery, Princess Alexandra Hospital NHS Trust , Harlow , UK
| | - K Kontzoglou
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - V Pergialiotis
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - L M Korou
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - M Frountzas
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - O Lalude
- Colorectal Department, General Surgery, Princess Alexandra Hospital NHS Trust , Harlow , UK
| | - N Nikiteas
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| | - D N Perrea
- Laboratory of Experimental Surgery and Surgical Research NS Christeas, National and Kapodistrian University of Athens , Athens , Greece
| |
Collapse
|
4
|
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.
Collapse
|
5
|
Boersema GSA, Wu Z, Kroese LF, Vennix S, Bastiaansen-Jenniskens YM, van Neck JW, Lam KH, Kleinrensink GJ, Jeekel J, Lange JF. Hyperbaric oxygen therapy improves colorectal anastomotic healing. Int J Colorectal Dis 2016; 31:1031-1038. [PMID: 27041554 PMCID: PMC4834105 DOI: 10.1007/s00384-016-2573-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Hyperbaric oxygen treatment (HBOT) has been found to improve the healing of poorly oxygenated tissues. This study aimed to investigate the influence of HBOT on the healing in ischemic colorectal anastomosis. METHODS Forty Wistar rats were randomly divided into a treatment group that received HBOT for 10 consecutive days (7 days before and 3 days after surgery), or in a control group, which did not receive the therapy. Colectomy with an ischemic anastomosis was performed in all rats. In each group, the rats were followed for 3 or 7 days after surgery to determine the influence of HBOT on anastomotic healing. RESULTS Five rats from each group died during follow-up. No anastomotic dehiscence was seen in the HBOT group, compared to 37.5 % and 28.6 % dehiscence in the control group on postoperative day (POD) 3 and 7, respectively. The HBOT group had a significantly higher bursting pressure (130.9 ± 17.0 mmHg) than the control group (88.4 ± 46.7 mmHg; p = 0.03) on POD 3. On POD 3 and POD 7, the adhesion severity was significantly higher in the control groups than in the HBOT groups (p < 0.005). Kidney function (creatinine level) of the HBOT group was significantly better than of the control group on POD 7 (p = 0.001). Interestingly, a significantly higher number of CD206+ cells (marker for type 2 macrophages) was observed in the HBOT group at the anastomotic area on POD 3. CONCLUSION Hyperbaric oxygen enhanced the healing of ischemic anastomoses in rats and improved the postoperative kidney function.
Collapse
Affiliation(s)
- G S A Boersema
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - Z Wu
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
| | - L F Kroese
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| | - S Vennix
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands
| | | | - J W van Neck
- Department of Plastic and Reconstructive Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - K H Lam
- Department of Pathology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - G J Kleinrensink
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J F Lange
- Department of Surgery, Laboratory of Experimental Surgery, Erasmus MC, University Medical Center, Room Ee-173 Postbus 2040, 3000 CA, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Poyrazoglu Y, Topal T, Yuksel R, Bircan FS, Simsek K, Gocgeldi E, Ersoz N, Korkmaz A. Effects of Hyperbaric Oxygen and Preconditioning on Wound Healing in Colonic Anastomoses. J INVEST SURG 2015; 28:188-95. [DOI: 10.3109/08941939.2014.999961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
7
|
Davis B, Rivadeneira DE. Complications of colorectal anastomoses: leaks, strictures, and bleeding. Surg Clin North Am 2012. [PMID: 23177066 DOI: 10.1016/j.suc.2012.09.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Intestinal anastomosis is an essential part of surgical practice, and with it comes the inherent risk of complications including leaks, strictures, and bleeding, which result in significant morbidity and occasional mortality. Understanding the myriad of risk factors and the strength of the data helps guide a surgeon as to the safety of undertaking an operation in which a primary anastomosis is to be considered. This article reviews the risk factors, management, and outcomes associated with anastomotic complications.
Collapse
Affiliation(s)
- Bradley Davis
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267, USA.
| | | |
Collapse
|
8
|
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: 0.7] [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.
Collapse
Affiliation(s)
- Antonio Angelo Rocha
- Post-graduate Program in Surgery, University of Campinas (UNICAMP), Campinas, SP, Brazil.
| | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
Unrecognized and untreated intraoperative hypothermia remains a common avoidable scenario in the modern operating room. Failure to properly address this seemingly small aspect of the total operative care has been shown to have profound negative patient consequences including increased incidence of postoperative discomfort, surgical bleeding, requirement of allogenic blood transfusion, wound infections, and morbid cardiac events. All of these ultimately lead to longer hospitalizations and higher mortality. To avoid such problems, simple methods can be employed by the surgeon, anesthesiologist, and ancillary personnel to ensure euthermia. Similarly, another effortless method to potentially improve surgical outcomes is the liberal use of supplemental oxygen. Promising preliminary data suggests that high-concentration oxygen during and after surgery may decrease the rate of surgical site infections and gastrointestinal anastomotic failure. The precise role of supplemental oxygen in the perioperative period represents an exciting area of potential research that awaits further validation and analysis. In this article, the authors explore the data regarding both temperature regulation and supplemental oxygen use in an attempt to define further their emerging role in the perioperative care of patients undergoing colorectal surgery.
Collapse
Affiliation(s)
- Vance Y Sohn
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA
| | | |
Collapse
|