Abstract
BackgroundAnastomotic leakage represents a major complication following resections in colorectal surgery. Among others, intestinal inflammation such as in inflammatory bowel disease is a significant risk factor for disturbed anastomotic healing. Despite technical advancements and several decades of focused research, the underlying mechanisms remain incompletely understood. Animal experiments will remain the backbone of this research in the near future. Here, instructions on a standardized and reproducible murine model of preoperative colitis and colorectal anastomosis formation are provided to amplify research on anastomotic healing during inflammatory disease.MethodsWe demonstrate the combination of experimental colitis and colorectal anastomosis formation in a mouse model. The model allows for monitoring of anastomotic healing during inflammatory disease through functional outcomes, clinical scores, and endoscopy and histopathological examination, as well as molecular analysis.DiscussionPostoperative weight loss is used as a parameter to monitor general recovery. Functional stability can be measured by recording bursting pressure and location. Anastomotic healing can be evaluated macroscopically from the luminal side by endoscopic scoring and from the extraluminal side by assessing adhesion and abscess formation or presence of dehiscence. Histologic examination allows for detailed evaluation of the healing process.ConclusionThe murine model presented in this paper combines adjustable levels of experimental colitis with a standardized method for colorectal anastomosis formation. Extensive options for sample analysis and evaluation of clinical outcomes allow for detailed research of the mechanisms behind defective anastomotic healing.
Highlights
Delayed or insufficient healing at the site of a colorectal anastomosis can lead to anastomotic leakage (AL) with the respective morbidity
C Colonoscope with attached light cable and 10-ml syringe for waterassisted colonoscopy. d Colonoscopy on anesthetized mouse in prone position. e–h Colonoscopies using air as a medium. e Well healed anastomosis on postoperative day 3 (POD3) compared to f anastomosis at POD3 with intraluminal bleeding around most of the circumference. g Well healed anastomosis on POD7 compared to h anastomosis on POD7 with a large fibrin patch at 6 o’clock
We demonstrate our combination model of experimental colitis and colorectal surgery as a feasible and adaptable setup for analysis of anastomotic healing during inflammatory conditions
Summary
Delayed or insufficient healing at the site of a colorectal anastomosis can lead to anastomotic leakage (AL) with the respective morbidity. Instructions on a standardized and reproducible murine model of preoperative colitis and colorectal anastomosis formation are provided to amplify research on anastomotic healing during inflammatory disease. Methods We demonstrate the combination of experimental colitis and colorectal anastomosis formation in a mouse model. The model allows for monitoring of anastomotic healing during inflammatory disease through functional outcomes, clinical scores, and endoscopy and histopathological examination, as well as molecular analysis. Conclusion The murine model presented in this paper combines adjustable levels of experimental colitis with a standardized method for colorectal anastomosis formation. Extensive options for sample analysis and evaluation of clinical outcomes allow for detailed research of the mechanisms behind defective anastomotic healing
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