Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

Pommergaard, Hans‐Christian; Achiam, Michael Patrick; Burcharth, Jakob; Rosenberg, Jacob

doi:10.9738/intsurg-d-13-00191.1

Cited by 23 publications

(8 citation statements)

References 15 publications

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“…Ischaemia is a factor for AL and it is thought that high levels of I‐FABP are the result of diminished blood supply in the splanchnic circulation . I‐FABPs are small proteins present in mature enterocytes at the tip of the villus and released into the circulation when the enterocyte membrane breaks down.…”

Section: Discussionmentioning

confidence: 99%

Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial

et al. 2017

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Aim Anastomotic leakage (AL) following abdominal surgery is a critical determinant of postoperative recovery, of which the aetiology is largely unknown. Interestingly, interventions aimed at reducing the inflammatory response and postoperative ileus (POI) have an unexpected effect on AL. The aim of this study was to investigate the relation of POI with inflammation and AL after colorectal resection.Method A post hoc analysis of a prospective randomized controlled trial in which patients underwent a colorectal resection was performed. Patients undergoing a colorectal resection were stratified into having or not having POI. The incidence of AL and other clinical parameters was registered prospectively. Intestinal fatty acid binding protein (I-FABP, a marker for tissue damage) and the inflammatory response in plasma and colon tissue were determined.Results AL was present in nine of 43 patients in the POI group, and in one of 65 in the group without POI (P < 0.001). There was a significant association between POI and AL (OR 12.57, 95% CI: 2.73-120.65; P = 0.0005). Patients with POI had significantly higher plasma levels of soluble tumour necrosis factor receptor 1 (TNFRSF1A) at 4 h postoperatively (0.89 ng/l, interquartile range 0.56) than patients without POI (0.80 ng/l, interquartile range 0.37; P = 0.04) and higher plasma levels of C-reactive protein on the second day postoperatively (234 AE 77 vs 163 AE 86 mg/l; P = 0.001). Patients who developed AL had significantly higher plasma levels of I-FABP compared with patients without AL at 24 h after onset of surgery.Conclusion POI is associated with a higher prevalence of AL and an increased inflammatory response.

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Section: Discussionmentioning

confidence: 99%

Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial

et al. 2017

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“…However, even though a leak might not yet be clinically evident at postoperative day 7, it can be assumed that the leak would have developed and, therefore, should be visible at death. Most, if not all, experimental studies on healing of intestinal anastomoses schedule the follow‐up within the first postoperative week.…”

Section: Discussionmentioning

confidence: 99%

Effect of oxygen‐producing suture material on hypoxic colonic anastomoses in an experimental model

et al. 2019

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BackgroundAnastomotic leak remains a significant cause of morbidity and mortality after colorectal surgery. Among multiple risk factors considered, hypoxia–ischaemia is considered to be a primary cause of intestinal anastomotic leakage. The aim of this experimental study was to assess safety, usability for surgical tasks, and efficacy of a newly developed oxygen‐producing suture material in the healing of colonic anastomoses under critical conditions.MethodsAn oxygen‐producing suture material was produced that is capable of releasing oxygen directly into the surrounding tissue. Off‐the‐shelf sutures loaded with calcium peroxide nano‐crystals and covered with poly(d,l‐lactide‐co‐glycolide) were assessed in vitro and in a rat model of hypoxic colonic anastomosis.Results In vitro assessment showed that these sutures can increase oxygen levels in a hypoxic environment. Potential oxygen byproducts did not seem to have a negative impact on the viability of intestinal cells. The use of oxygen‐producing sutures in vivo resulted in increased tissue oxygen saturation, measured by visible light spectroscopy, and increased mechanical stability of the anastomosis.ConclusionOxygen‐producing suture material increased tissue oxygen saturation and mechanical stability of colonic anastomosis in a rat model.Surgical relevanceLeakage of anastomoses remains a significant problem after colorectal surgery.An oxygen‐producing suture material was produced that was shown to be safe in vitro and significantly improved several aspects of healing of colonic anastomoses in an animal model.Oxygen‐producing suture material or stapler devices might help to reduce the risk of anastomotic leak of intestinal anastomoses under physiological and critical conditions such as hypoxia.

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“…Blood flow is always reduced in the suture line compared with the normal mucosa. [15,16] Of all the anastomosis studied, the blood flow of the suture line decreased from the single-layer manual to the 2-layer manual to the stapled suture. [17,18] But for pediatric patients, the single-layer anastomosis is really difficult to perform for the so thin of the intestinal wall and some challenging surgical positions.…”

Section: Discussionmentioning

confidence: 99%

Reduced rate of dehiscence after implementation of a novel technique for creating colonic anastomosis in pediatric patients undergoing intestinal anastomosis in a single institute

Yang¹,

Chen²,

et al. 2019

Medicine

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We aimed to investigate the new continuous horizontal mattress anastomosis for pediatric patients who underwent emergency or electively laparotomy. From June 2012 to June 2017, 858 patients undergoing intestinal anastomosis were reviewed retrospectively, including 369 patients with the new continuous horizontal mattress anastomosis and 489 patients with traditional 2 layer interrupted anastomosis, served as control. Propensity score matching was performed to adjust for selected baseline variables. The primary outcome, anastomosis complications and clinical outcomes, including postoperative gastrointestinal function recovery, overall expenditure, and postoperative hospital stay were compared between the 2 groups. Patients with the new manual anastomosis had advantageous postoperative outcomes than those with the traditional 2 layer interrupted anastomosis. A mean of 11.4 minutes was required to construct the new manual single-layer anastomosis versus 18.5 minutes for the traditional anastomosis ( P < .001). A reduction trend for postoperative anastomotic complications was indicated in patients receiving horizontal mattress anastomosis (odds ratio [OD] (95% confidence interval [CI]), 0.56 (0.37–0.84); P = .004), including peritonitis or abscess (OD [95% CI], 0.56 (0.32–0.98); P = .026), anastomotic leakage (OD [95% CI], 0.39 [0.12–1.27]; P = .088), and anastomotic strictures ( P = .26). Mean length of stay was 10.9 ± 2.9 days for the new manual anastomosis group and 11.3 ± 3.5 days for traditional 2-layer anastomosis patients ( P = .12). Beneficial effects of the new manual anastomosis were demonstrated in terms of anastomotic complications, and length of hospital stay in the pediatric patients. Furthermore, it is a novel, feasible and safe method that may simplify the surgical procedure in anastomoses.

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Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

Cited by 23 publications

References 15 publications

Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial

Relation between postoperative ileus and anastomotic leakage after colorectal resection: a post hoc analysis of a prospective randomized controlled trial

Effect of oxygen‐producing suture material on hypoxic colonic anastomoses in an experimental model

Reduced rate of dehiscence after implementation of a novel technique for creating colonic anastomosis in pediatric patients undergoing intestinal anastomosis in a single institute

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