Early Anastomotic Repair in the Rat Intestine is Affected by Transient Preoperative Mesenteric Ischemia

Posma, Lisanne A. E.; Bleichrodt, R. P.; Lomme, Roger M. L. M.; Man, Ben M. de; Goor, Harry van; Hendriks, T.

doi:10.1007/s11605-009-0827-5

Cited by 15 publications

(14 citation statements)

References 26 publications

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“…If a pressure of only 5 mmHg CO 2 was applied, this negative effect was not seen. Recent experimental work showed that ischemia-induced injury has greatest impact on intestinal anastomotic healing during the first 2 days after surgery [9]. In our study, a similar effect was still seen after a prolonged interval of 7 days.…”

Section: Discussionsupporting

confidence: 84%

The influence of the CO2 pneumoperitoneum on a rat model of intestinal anastomosis healing

2011

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BackgroundThe CO2 pneumoperitoneum, which is used for laparoscopic surgery, causes local and systemic effects in patients. Concern arises about what the pressurized anoxic environment of the CO2 pneumoperitoneum has on intestinal healing. Earlier experimental work showed a negative correlation between intestinal healing and the applied intra-abdominal pressure. To further elucidate this, we developed a rat model, in which enterotomy healing can be compared after open or laparoscopic surgery. Possible mechanisms of injury, such as impaired neoangiogenesis or injury through hypoxia-induced pathways were studied.MethodsA new experimental mechanically ventilated rat model was developed. An enterotomy was made and closed via laparotomy (group I) or laparoscopy under CO2 pressures of 5 mmHg (group II) or 10 mmHg (group III). Intestinal healing was tested in vivo after 1 week by bursting-pressure analysis. The effect of the operative procedure on neoangiogenesis was tested by counting factor VIII positive vessels in biopsies of the perianastomotic granulation tissue after 1 week. Intestinal anoxia was tested by quantifying HIF-1α protein levels in intestinal biopsies, taken before the enterotomy closure.ResultsThe bursting pressures were significantly lower after laparoscopic surgery at 10 mmHg CO2 pneumoperitoneum (group III) compared with rats that had undergone open surgery (group I) or laparoscopic surgery at 5 mmHg CO2 pneumoperitoneum (group II). There was no significant quantitative difference between the three groups in the neoangiogenesis nor was there a difference in the amount of HIF-1α measured in the intestinal biopsies.ConclusionsWe developed a surgical model that is well fitted to study the effects of pneumoperitoneum on intestinal healing. With this model, we found further evidence of CO2 pressure-dependant hampered intestinal healing. These differences could not be explained by difference in neoangiogenesis nor local upregulation of hypoxic factors.

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Section: Discussionsupporting

confidence: 84%

The influence of the CO2 pneumoperitoneum on a rat model of intestinal anastomosis healing

2011

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“…The identified risk factors for anastomotic leakage are composed of patient factors, which include malnutrition, weight loss, steroid use, smoking, alcohol, American Society of Anesthesiologists score > 3 points, various concurrent diseases such as cardiovascular disease and diverticulitis, and surgical factors, including a low level of anastomosis, an operation time > 2 hours, intraperitoneal fecal contamination, anastomotic tension, distal intestinal obstruction, and ischemia in the anastomosis [5]. Among these various causes of anastomotic leakage, ischemia around the anastomosis would be considered a strongly affective factor for repair of an anastomotic site [6, 7]. Several chemical agents have been introduced to attenuate ischemic injury to the colon, but their effect has not been promising, and there is a dearth of data regarding leakage prevention [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Adipose-tissue-derived Stem Cells Enhance the Healing of Ischemic Colonic Anastomoses: An Experimental Study in Rats

Yoo

Shin

et al. 2012

J Korean Soc Coloproctol

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PurposeThis experimental study verified the effect of adipose-tissue-derived stem cells (ASCs) on the healing of ischemic colonic anastomoses in rats.MethodsASCs were isolated from the subcutaneous fat tissue of rats and identified as mesenchymal stem cells by identification of different potentials. An animal model of colonic ischemic anastomosis was induced by modifying Nagahata's method. Sixty male Sprague-Dawley rats (10-week-old, 370 ± 50 g) were divided into two groups (n = 30 each): a control group in which the anastomosis was sutured in a single layer with 6-0 polypropylene without any treatment and an ASCtreated group (ASC group) in which the anastomosis was sutured as in the control group, but then ASCs were locally transplanted into the bowel wall around the anastomosis. The rats were sacrificed on postoperative day 7. Healing of the anastomoses was assessed by measuring loss of body weight, wound infection, anastomotic leakage, mortality, adhesion formation, ileus, anastomotic stricture, anastomotic bursting pressure, histopathological features, and microvascular density.ResultsNo differences in wound infection, anastomotic leakage, or mortality between the two groups were observed. The ASC group had significantly more favorable anastomotic healing, including less body weight lost, less ileus, and fewer ulcers and strictures, than the control group. ASCs augmented bursting pressure and collagen deposition. The histopathological features were significantly more favorable in the ASC group, and microvascular density was significantly higher than it was in the control group.ConclusionLocally-transplanted ASCs enhanced healing of ischemic colonic anastomoses by increasing angiogenesis. ASCs could be a novel strategy for accelerating healing of colonic ischemic risk anastomoses.

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“…Small intestine and colonic anastomoses are simple to perform in rodents, as compared to esophagogastric anastomoses [15,16,17]. …”

Section: Discussionmentioning

confidence: 99%

Model of Wound Healing for Esophagogastric Anastomoses in Rats

Drescher¹,

Vogt²,

Gabriel³

et al. 2012

Eur Surg Res

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Background: Anastomotic leakage after esophageal surgery is a significant cause of morbidity and mortality. Postoperative leakage of esophagogastric anastomosis has been reported in 2–30% of surgical patient, resulting in an increased need for reoperation and a high risk of subsequent esophageal stricture formation and fistula. So far, experimental investigations on major factors influencing the healing of esophageal anastomoses, e.g. neovascularization and collagen deposition, have been hindered by the lack of a functional rodent model. Methods: We developed a novel technique of gastric tube formation followed by end-to-end esophagogastric anastomosis in a rat model. Standardized anastomoses were carried out in 18 Brown-Norway rats and normal esophagogastric healing was studied by measuring anastomotic breaking strength 5 days after surgery. Results: Five animals showed an insufficiency of the esophagogastric anastomosis as determined by anastomotic leakage testing. Normal anastomotic healing was found in 10 animals. The anastomotic breaking strength was 1.93 ± 0.45 N. Conclusion: The rat model for performing esophagogastric anastomoses after gastric tube formation may serve as a functional and useful model in future research studies on microvascular and molecular processes of anastomotic healing.

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Early Anastomotic Repair in the Rat Intestine is Affected by Transient Preoperative Mesenteric Ischemia

Cited by 15 publications

References 26 publications

The influence of the CO2 pneumoperitoneum on a rat model of intestinal anastomosis healing

The influence of the CO2 pneumoperitoneum on a rat model of intestinal anastomosis healing

Adipose-tissue-derived Stem Cells Enhance the Healing of Ischemic Colonic Anastomoses: An Experimental Study in Rats

Model of Wound Healing for Esophagogastric Anastomoses in Rats

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