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Uzunlu O, Aydın E, Çomut E, Avcı E, Şenol H. The comparison of the suture materials on intestinal anastomotic healing: an experimental study. ULUS TRAVMA ACIL CER 2023; 29:956-962. [PMID: 37681730 PMCID: PMC10560814 DOI: 10.14744/tjtes.2023.86579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/03/2023] [Accepted: 08/02/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND This experimental comparative study was to evaluate the local effects of three different suture materials on in-testinal anastomosis healing. METHODS Ethical approval was obtained from the University of Ethical Committee (E-60758568-020-176720). A prospective, experimental comparative analysis was conducted on 24 rats. They were divided into three equal groups; Group 1 underwent colonic anastomosis with Vicryl suture material, Group 2 underwent colonic anastomosis with polypropylene suture; and Group 3 underwent colonic anastomosis with polydioxanone (PDS) suture. The second operation underwent the 7th post-operative day. Adhesion score, anastomotic leakage, anastomotic bursting pressure, hydroxyproline levels, and histopathologic examination were evaluated. RESULTS All animals survived, and no leakage, intestinal obstruction, or wound infection was observed during the experiment. The adhesion score was evaluated according to the Diamond classification and same in all groups. Median anastomotic bursting pressure was 125.75 mmHg (10-241) in the Vicryl group, 159.25 mmHg (113-190) in the polypropylene group, and 154.50 mmHg (20-212) in the PDS group. Hydroxyproline tissue concentrations were in the Vicryl group 1699.92±220.8 ng/mg (range: 1509.81-2186.47), in the polypropylene group 1126.24±607.12 ng/mg (range: 53.22-1815.63), and 1547.86±335.2 ng/mg (range: 973.66-1973.2) in PDS group. There was no difference among groups regarding the inflammatory response evaluated by histopathology. There was no statistical significance in all variables evaluated. CONCLUSION This experimental study demonstrates that suture materials did not worsen tissue healing during intestinal anastomosis. Absorbable, slowly-absorbable, and non-absorbable suture materials could be used safely in every situation.
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Affiliation(s)
- Osman Uzunlu
- Department of Pediatric Surgery, Pamukkale University, School of Medicine, Denizli-Türkiye
| | - Emrah Aydın
- Department of Pediatric Surgery, Namık Kemal University, School of Medicine, Tekirdağ-Türkiye
| | - Erdem Çomut
- Department of Pathology, Pamukkale University, School of Medicine, Denizli-Türkiye
| | - Esin Avcı
- Department of Biochemistry, Pamukkale University, School of Medicine, Denizli-Türkiye
| | - Hande Şenol
- Department of Statistics, Pamukkale University, School of Medicine, Denizli-Türkiye
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Schweer JT, Neumann PA, Doebler P, Doebler A, Pascher A, Mennigen R, Rijcken E. Crohn's Disease as a Possible Risk Factor for Failed Healing in Ileocolic Anastomoses. J Clin Med 2023; 12:jcm12082805. [PMID: 37109142 PMCID: PMC10141622 DOI: 10.3390/jcm12082805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Anastomotic leakage (AL) after colorectal resections is a serious complication in abdominal surgery. Especially in patients with Crohn's disease (CD), devastating courses are observed. Various risk factors for the failure of anastomotic healing have been identified; however, whether CD itself is independently associated with anastomotic complications still remains to be validated. A retrospective analysis of a single-institution inflammatory bowel disease (IBD) database was conducted. Only patients with elective surgery and ileocolic anastomoses were included. Patients with emergency surgery, more than one anastomosis, or protective ileostomies were excluded. For the investigation of the effect of CD on AL 141, patients with CD-type L1, B1-3 were compared to 141 patients with ileocolic anastomoses for other indications. Univariate statistics and multivariate analysis with logistic regression and backward stepwise elimination were performed. CD patients had a non-significant higher percentage of AL compared to non-IBD patients (12% vs. 5%, p = 0.053); although, the two samples differed in terms of age, body mass index (BMI), Charlson comorbidity index (CCI), and other clinical variables. However, Akaike information criterion (AIC)-based stepwise logistic regression identified CD as a factor for impaired anastomotic healing (final model: p = 0.027, OR: 17.043, CI: 1.703-257.992). Additionally, a CCI ≥ 2 (p = 0.010) and abscesses (p = 0.038) increased the disease risk. The alternative point estimate for CD as a risk factor for AL based on propensity score weighting also resulted in an increased risk, albeit lower (p = 0.005, OR 7.36, CI 1.82-29.71). CD might bear a disease-specific risk for the impaired healing of ileocolic anastomoses. CD patients are prone to postoperative complications, even in absence of other risk factors, and might benefit from treatment in dedicated centers.
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Affiliation(s)
- Julian Thomas Schweer
- Department of General, Visceral, and Transplantation Surgery, Muenster University Hospital, 48149 Muenster, Germany
| | - Philipp-Alexander Neumann
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich School of Medicine, 81675 Munich, Germany
| | - Philipp Doebler
- Department of Statistics, Chair of Statistical Methods in Social Sciences, Technical University of Dortmund, 44227 Dortmund, Germany
| | - Anna Doebler
- Psychological Assessment and Methods Group, Institute of Psychology, Faculty of Educational Sciences, University of Duisburg-Essen, 45141 Essen, Germany
| | - Andreas Pascher
- Department of General, Visceral, and Transplantation Surgery, Muenster University Hospital, 48149 Muenster, Germany
| | - Rudolf Mennigen
- Medizinisches Versorgungszentrum Portal 10, 48155 Muenster, Germany
| | - Emile Rijcken
- Department of General, Visceral, and Transplantation Surgery, Muenster University Hospital, 48149 Muenster, Germany
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Weber MC, Bauer J, Buck A, Clees Z, Oertel R, Kasajima A, Reischl S, Wilhelm D, Friess H, Neumann PA. Perioperative low-dose prednisolone treatment has beneficial effects on postoperative recovery and anastomotic healing in a murine colitis model. J Crohns Colitis 2023:6987223. [PMID: 36638152 DOI: 10.1093/ecco-jcc/jjad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS High-dose glucocorticoid treatment has been identified as a risk factor for anastomotic leakage in patients with inflammatory bowel disease (IBD) undergoing bowel resection surgery. On the contrary, active disease during surgery is also associated with elevated morbidity. Perioperative low-dose treatment might be beneficial regarding postoperative outcomes by controlling disease activity. The present study is the first to investigate the dose-dependent effect of perioperative prednisolone therapy in a murine IBD model combining dextran-sodium sulfate (DSS) colitis with intestinal anastomosis surgery. METHODS In 84 ten-week-old wild-type mice a colorectal anastomosis was performed using microsurgical technique. Half the animals received induction of chemical colitis with 2% DSS via drinking water prior to surgery. In both groups, one third of the animals received daily oral administration of high-dose (0.533 mg/kg) and one third low-dose (0.133 mg/kg) prednisolone. Evaluation was performed on postoperative day 3 and 7. RESULTS While high-dose prednisolone treatment led to an increased anastomotic leakage rate in mice under colitis, low-dose prednisolone treatment limited preoperative disease activity and did not influence the leakage rate. Histologic examination showed a beneficial effect of low-dose prednisolone treatment on microscopic abscess formation at the anastomotic site in DSS mice as well as an increased anastomotic healing score. CONCLUSIONS We could demonstrate a beneficial effect of perioperative short-term low-dose prednisolone treatment on intestinal anastomotic healing in the context of colitis. Perioperative use of short-term low-dose prednisolone treatment might be beneficial in IBD patients that need to undergo surgery during active disease.
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Affiliation(s)
- Marie-Christin Weber
- Department of Surgery, TUM School of Medicine, Technical University of Munich , Munich, Germany
| | - Jannick Bauer
- Department of Surgery, TUM School of Medicine, Technical University of Munich , Munich, Germany
| | - Annalisa Buck
- Department of Surgery, TUM School of Medicine, Technical University of Munich , Munich, Germany
| | - Zoé Clees
- Department of Surgery, TUM School of Medicine, Technical University of Munich , Munich, Germany
| | - Reinhard Oertel
- Institute of Clinical Pharmacology, Technical University of Dresden , Dresden, Germany
| | - Atsuko Kasajima
- Institute of Pathology, TUM School of Medicine, Technical University of Munich , Munich, Germany
| | - Stefan Reischl
- Department of Surgery, TUM School of Medicine, Technical University of Munich , Munich, Germany.,Department of Diagnostic and Interventional Radiology, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Dirk Wilhelm
- Department of Surgery, TUM School of Medicine, Technical University of Munich , Munich, Germany
| | - Helmut Friess
- Department of Surgery, TUM School of Medicine, Technical University of Munich , Munich, Germany
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Nygaard MS, Jul MS, Debrabant B, Madsen GI, Qvist N, Ellebæk MB. Remote ischemic postconditioning has a detrimental effect and remote ischemic preconditioning seems to have no effect on small intestinal anastomotic strength. Scand J Gastroenterol 2022; 57:768-774. [PMID: 35196954 DOI: 10.1080/00365521.2022.2041715] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effect of remote pre- and postconditioning on anastomotic healing has been sparsely studied. The aim of our study was to investigate whether remote ischemic conditioning (RIC) applied before and after the creation of a small bowel anastomosis had an effect on anastomotic healing on postoperative day five evaluated by a tensile strength test and histological analysis. MATERIALS AND METHODS Twenty-two female piglets were randomized into two groups. The intervention group (n = 12) received RIC on the forelimbs consisting of 15 min of ischemia followed by 30 min of reperfusion before the first end-to-end ileal anastomosis was created. The RIC procedure was repeated and the second and more distal anastomosis was performed. The control group (n = 10) had two similar anastomoses with similar time intervals but without RIC. On postoperative day five, the anastomoses were subjected to macroscopic evaluation, tensile strength test and histological examination. RESULTS Mean tensile strength when the first transmural rupture appeared (MATS-2) was significantly lower in the first anastomosis in the intervention group compared to the control group (11.4 N vs 14.7 N, p < .05). Similar result was found by the maximal strength (MATS-3) as defined by a drop in the load curve (12.3 N vs 15.9 N, p < .05). Histologically, a significantly higher necrosis score was found in the anastomosis in the intervention group (1.4 vs 0.8, p < .05). No other significant differences were found. CONCLUSIONS In conclusion, post-anastomotic remote ischemic conditioning had a detrimental effect and pre-anastomotic conditioning seems to have no effect on small intestinal anastomotic strength.
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Affiliation(s)
- Mathilde Skov Nygaard
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Mie Strandby Jul
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Birgit Debrabant
- Department of Public Health, Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense C, Denmark
| | - Gunvor Iben Madsen
- Research Unit for Pathology, Odense University Hospital, Odense, Denmark; University oif Southern Denmark, Odense, Denmark
| | - Niels Qvist
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
| | - Mark Bremholm Ellebæk
- Research Unit for Surgery, Odense University Hospital, Odense, Denmark; University of Southern Denmark, Odense, Denmark
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Yu K, Chen Z. Risks of anastomotic leakage in patients with colorectal cancer after operation and how to effectively avoid it. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:1031-1040. [PMID: 34707015 PMCID: PMC10930173 DOI: 10.11817/j.issn.1672-7347.2021.200569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Indexed: 11/03/2022]
Abstract
Despite the considerable progress in surgical level and imaging examination methods, anastomotic leakage is still the major complication after intestinal surgery with high incidence rate and mortality rate. Moreover, anastomotic leakage has become one of the serious complications threatening the postoperative life safety, prognosis and quality of life. The occurrence of anastomotic leakage involves the changes of a variety of pathophysiological factors, and is affected by intestinal microbiota, inflammation and immune system. Preoperative intestinal preparation will change the type and number of microbial population in the intestine. Intraoperative anastomotic mode and bleeding volume are also closely related to the occurrence of anastomotic leakage. In addition, the occurrence of anastomotic leakage is associated with local recurrence of colorectal cancer after surgery. Intraoperative protective stoma is confirmed to reduce the incidence of anastomotic leakage. Combined preoperative adjustment of nutritional status and inflammatory factors is important for avoiding anastomotic leakage after surgery.
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Affiliation(s)
- Kexun Yu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Zihua Chen
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
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Deng Y, Ren J, Chen G, Wang G, Gu G, Li J. Tannin-based adhesive for protection of colonic anastomosis in the open abdomen. J Biomater Sci Polym Ed 2016; 28:312-322. [PMID: 27910727 DOI: 10.1080/09205063.2016.1268462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study was aimed to evaluate the effect of tannin acid- polyethylene glycol (TP) adhesive on the wound healing process of primary colonic anastomosis in the open abdomen (OA). Adhesion strength test, degradation and hemostatic ability of TP were investigated. In a rat model, after standard colonic anastomoses, rats were divided into three groups: OA group; OA + FG (fibrin glue) group; OA + TP group. Five days after surgery, body weight, anastomotic bursting pressure (ABP), and histology of anastomotic tissue were evaluated. Performance of adhesion strength and hemostatic ability of TP was better than that of FG. The weight of TP decreased by over 50% after 11-day incubation. All rats survived well after surgery. Compared to OA group and OA + FG group, OA + TP group showed a significant improvement in body weight, ABP and healing state. Application of TP adhesive, used as an auxiliary treatment of colonic anastomosis operation, improved the wound strength and promoted the anastomotic healing after OA.
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Affiliation(s)
- Youming Deng
- a Department of General Surgery , Jinling Hospital, Medical School of Nanjing University , Nanjing , P.R. China
| | - Jianan Ren
- a Department of General Surgery , Jinling Hospital, Medical School of Nanjing University , Nanjing , P.R. China
| | - Guopu Chen
- a Department of General Surgery , Jinling Hospital, Medical School of Nanjing University , Nanjing , P.R. China
| | - Gefei Wang
- a Department of General Surgery , Jinling Hospital, Medical School of Nanjing University , Nanjing , P.R. China
| | - Guosheng Gu
- a Department of General Surgery , Jinling Hospital, Medical School of Nanjing University , Nanjing , P.R. China
| | - Jieshou Li
- a Department of General Surgery , Jinling Hospital, Medical School of Nanjing University , Nanjing , P.R. China
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Gündoğdu RH, Yaşar U, Ersoy PE, Ergül E, Işıkoğlu S, Erhan A. Effects of preoperative nutritional support on colonic anastomotic healing in malnourished rats. Turk J Surg 2015; 31:113-7. [PMID: 26504412 DOI: 10.5152/ucd.2015.3077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/12/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE It has been proven that malnutrition increases postoperative morbidity and mortality, and it may also negatively affect wound healing in the gastrointestinal tract. In the literature, there is only one study evaluating the effects of preoperative nutritional support on colonic anastomotic healing under malnourished conditions. In order to improve the data on this topic, an experimental study was planned to evaluate the effects of preoperative nutritional support on colonic anastomotic healing in malnourished rats. MATERIAL AND METHODS The study included 18 male Wistar albino rats divided into 3 groups. The control (C) group was fed ad libitum for 21 days. The malnutrition (M) group and preoperative nutrition (P) group were given 50% of the daily food consumed by the rats in Group C for 21 days to induce malnutrition. At the end of 21 days, Group P was fed ad libitum for 7 days (preoperative nutritional support). Colonic transection and end-to-end anastomosis was performed at 21 days in Group C and Group M and at 28 days in Group P. The rats were sacrificed at postoperative 4 days, anastomotic bursting pressure was measured, and samples were taken to analyze tissue hydroxyproline levels. RESULTS Anastomotic bursting pressure was significantly higher in Group C than in Group M and Group P (p<0.05), and it was significantly higher in Group P than in Group M (p<0.05). Tissue hydroxyproline levels in Group P were found to be significantly higher than those in Group M and Group C (p<0.05). CONCLUSION One week of preoperative nutritional support increases collagen synthesis in the colon and positively affects anastomotic healing under malnourished conditions.
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Affiliation(s)
- Rıza Haldun Gündoğdu
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Uğur Yaşar
- Clinic of General Surgery, Darende Hulusi Efendi State Hospital, Malatya, Turkey
| | - Pamir Eren Ersoy
- Clinic of General Surgery, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Emre Ergül
- Clinic of General Surgery, Dr. Hulusi Alataş Elmadağ Hospital, Ankara, Turkey
| | - Semra Işıkoğlu
- Afyon Public Health Laboratory, Biochemistry, Afyon, Turkey
| | - Atilla Erhan
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
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Affiliation(s)
- Karsten Bartels
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Matthew Fiegel
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Quinn Stevens
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Bryan Ahlgren
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Nathaen Weitzel
- Department of Anesthesiology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.
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