Effect of Ischemia/Reperfusion as a Systemic Phenomenon on Anastomotic Healing in the Left Colon

Abstract

Intestinal ischemia/reperfusion provokes a local inflammatory response leading to a systemic inflammatory state. In this study we aimed to assess the effects of intestinal ischemia/reperfusion injury on anastomotic healing in the left colon with an intact vascular supply. A total of 94 Wistar albino rats were divided into three groups: sham-operated control (group I, n = 25), 30 minutes of intestinal ischemia/reperfusion (group II, n = 40), and 7-day allopurinol pretreatment and intestinal ischemia/reperfusion (group III, n = 29). After the reperfusion experiment, a segmental left colon resection and anastomosis were done. On postoperative days 3 and 7 anastomotic bursting pressure, anastomotic and operative complications, and intraabdominal adhesions were assessed. Mortality rates were 1/25, 16/40, and 4/29 for groups I, II, and III, respectively (p = 0.001). There was no difference among the groups for wound and anastomotic healing parameters evaluated by macroscopic criteria. On postoperative day 7 the mean bursting pressures were 220.3 +/- 18.5, 162.0 +/- 21.0, and 213.9 +/- 24.7 for groups I, II, and II, respectively (p = 0.000). Significantly dense adhesions were found in group II (p = 0.000). Allopurinol pretreatment prevented the effects of ischemia/reperfusion on anastomotic healing of the left colon. Intestinal/ischemia reperfusion causes impairment of anastomotic healing of the left colon. In addition to remote organ effects, reperfusion injury may affect anastomotic healing in the viscera with an intact vascular supply.

Melatonin exhibit supportive effects on oxidants and anastomotic healing during intestinal ischemia reperfusion injury

“…Preoperative or intraoperative IRIs may also affect wound healing and decrease anastomotic durability. [3] Most of the general factors suggest that the vasoconstrictive effects are the cause of local ischemia and dehiscence of an anastomosis. Perfusion and the state of local oxygenation are some of the most important factors for healing gastrointestinal anastomoses.…”

“…They concluded that segmental small intestinal, unilateral lower extremity, and unilateral renal IR significantly delay anastomotic healing in the right colon. Similarly, Kuzu et al [3] showed that reperfusion stress after SMA ischemia cause a delay in the anastomotic healing process in the left colon.…”

“…Furthermore, to see the effect of melatonin on intestinal anastomosis, the rats were sacrificed at the end of 7 days. [3,15] Although many methods to assess anastomotic healing have been defined, the most frequently used techniques are BP and tensile strength measurements. [4,28] An optimal tissue perfusion and oxygen delivery is essential for fibroblasts, macrophages, lysine, and proline hydroxylation for collagen synthesis.…”

“…In addition to mesenteric embolism, bowel obstruction and trauma are related to intestiCite this article as: Özkan N, Ersoy ÖF, Özsoy Z, Çakır E. Melatonin exhibits supportive effects on oxidants and anastomotic healing during intestinal ischemia/reperfusion injury. Ulus Travma Acil Cerrahi Derg 2018;24: [1][2][3][4][5][6][7][8] Recent studies have shown that antioxidants, such as Nacetylcysteine, superoxide dismutase (SOD), catalase (CAT), selenium, and vitamins E and C, can prevent IR-associated adverse effects of oxygen radicals and ROS and improve wound healing. [7,8] Melatonin, the pineal hormone, is a powerful antioxidant and free radical scavenger of ROS, including the hydroxyl and peroxyl radicals, as well as singlet oxygen and nitric oxide.…”

The Effects of Hyperbaric Oxygen Therapy on Experimental Colon Anastomosis After Preoperative Chemoradiotherapy

“…In addition, other studies have suggested that burst occurring outside of the anastomosis line is frequent during BP measurements performed after postoperative day 5. [47][48][49][50][51] In the present study, BP was measured on the postoperative day 5. It was observed that burst occurred outside of the anastomosis line in 4 rats.…”