Anastomotic Segment Research Articles

Long-term anti-inflammatory efficacy in intestinal anastomosis in mice using silver nanoparticle-coated suture

BackgroundIn our previous study, we coated silver nanoparticles (AgNPs) onto the surface of absorbable braided suture using layer-by-layer deposition and demonstrated significant anti-inflammatory property during the early phase of intestinal anastomosis healing in mice. The present study aimed to further investigate the long-term anti-inflammatory efficacy. MethodsAgNP-coated suture, antibiotic coated suture, and normal suture were respectively used for single layered, interrupted intestinal anastomosis. The anastomotic segments in each group were harvested on day 14, day 21, and day 28 postoperation and investigated for the degree of inflammation by cell infiltration and expression of cytokines as well as collagen deposition. ResultsWhen compared with the control groups, the AgNP-coated suture group showed better histological appearance in the intestinal anastomotic segments at each time point. Immunohistochemistry staining and quantitative evaluation further indicated less macrophage infiltration and decreased production of IL-6, IL-10, and TNF-α (p<0.05). Masson staining showed normal collagen deposition and remodeling at intestinal anastomotic tissue in the AgNP-coated suture group. ConclusionOur study shows that AgNP-coated suture provides better long-term anti-inflammatory efficacy and ideal tissue remodeling in intestinal anastomosis. Despite these findings, clinical trials are still needed for evaluation before medical application.

Small Bowel Obstruction Caused by Epstein-Barr Virus Positive Extranodal Hodgkinʼs Lymphoma in a Patient with Crohnʼs Disease: A Case Report

Literature in the IBD population has reported increased risks for malignancy including lymphoproliferative disorders associated with biologic and thiopurine medications. A 55 year old male with a history of Crohn's disease presented with multiple symptoms of mid-abdominal pain, nausea, vomiting, constipation, and lack of flatus for three days. He had previous intestinal resections and intermittent therapy including systemic steroids, infliximab, azathioprine, and 5-ASA. The patient was found to have a small bowel obstruction which required surgical intervention and a nonpatent segment of an ileocolonic anastomosis was resected. Histological analysis of the resected anastomotic segment revealed positivity for PAX5, CD30, BCL-2, OCT-2, MUM1 for large cells. Neoplastic cells showed altered B-cell phenotype and decreased expression of PAX5, CD20, CD79a and BOB.1 consistent with Reed Sternberg cells. In-situ hybridization was positive for EBER confirming Epstein-Barr virus. The patient was diagnosed with ileocolonic anastomosis EBV positive classical Hodgkin lymphoma in Crohn's disease.Figure 1Figure 2Figure 3

Effect of hemorrhagic shock on intestinal anastomoses’ healing

Background/Purpose: Hypovolemia and shock is increasingly frequent in the perioperative of intestinal anastomoses, especially due to abdominal trauma. The aim of this study is to evaluate the effects of hemorrhagic shock in the healing of intestinal anastomoses in rats. Methods: It was analyzed the shock interference on the strength of ileum anastomoses. Histologically, structural changes of the anastomotic segments were assessed by two pathologists. Data are given as mean ± SEM. The animals were randomly selected and assigned in two groups with six rats each: Group 1 - rats with hypovolemic shock (shocked+enterectomy) treated with fresh whole blood. Group 2 - rats not shocked, untreated + enterectomy. Results: The intestinal anastomosis bursting pressure of shock+enterectomy group rats was lower than in the unshocked+enterectomy group, and the difference was significant (p=0.001). In the hemorrhagic shock+enterectomy group rats the density of collagen and fibrous tissue was lower and inflammation/foreign body reaction was higher than in the unshocked+enterectomy group, featuring a more immature and deficient healing. Conclusion: In conclusion, the results show that the hypovolemic shock affects the ileum wound healing, causing a decrease in the bursting pressure (mmHg) of ileal anastomosis, leading to the fragility of the surgical wound.

Functional diagnostic parameters for arteriovenous fistula.

The inability to detect the arteriovenous fistula (AVF) dysfunction in a timely manner under the current surveillance programs, which are based on either diameter (d), flow rate (Q), or pressure (p) measurements, is one of the major challenges of dialysis treatment. Thus, our aim is to introduce new functional diagnostic parameters that can better predict AVF functionality status. Six AVFs were created between the femoral arteries and veins of three pigs, each pig having two AVFs on either limb. Flow fields and pressure drop (Δp) in AVFs were obtained via numerical analysis utilizing the CT scan and Doppler ultrasound data at 2D (D: days), 7D, and 28D postsurgery. The dataset included 16 (two pigs [four AVFs] for three time points, and one pig [two AVFs] for two time points) repeated measurements over time, and the statistical analysis was done using a mixed model. To evaluate the nature of pressure drop-flow relationships in AVFs, the Δp was correlated with the average velocity at proximal artery (v) and also the corresponding scaled velocity (v*) by the curvature ratio of anastomotic segment. Based on these relationships, two new functional diagnostic parameters, including the nonlinear pressure drop coefficient (Cp ; pressure drop divided by dynamic pressure at proximal artery) and the linear resistance index (R; pressure drop divided by velocity at proximal artery), were introduced. The diagnostic parameters that were calculated based on scaled velocity are represented as R* and Cp *. A marginal (P = 0.1) increase in d from 2D (5.4 ± 0.7 mm) to 7D (6.8 ± 0.7 mm), along with a significant increase in Q (2D: 967 ± 273 mL/min; 7D: 1943 ± 273 mL/min), was accompanied by an almost unchanged Δp over this time period (2D: 16.42 ± 4.6 mm Hg; 7D: 16.40 ± 4.6 mm Hg). However, the insignificant increase in d and Q from 7D to 28D (d = 7.8 ± 0.8 mm; Q = 2181 ± 378 mL/min) was accompanied by the elevation in Δp (24.6 ± 6.5 mm Hg). The functional diagnostic parameters, R and Cp , decreased from 2D (R = 22.4 ± 2.8 mm Hg/m/s; Cp = 12.0 ± 2.6) to 7D (R = 20.8 ± 2.8 mm Hg/m/s; Cp = 8.1 ± 2.6), and then increased from 7D to 28D (R = 35.5 ± 5.7 mm Hg/m/s; Cp = 17.5 ± 3.6) with a marginal significance. However, when the scaled velocity was used to calculate R* and Cp *, the increase in diagnostic parameters from 7D to 28D achieved statistical significance (P < 0.05). In summary, although the differences in the hemodynamic parameters (d, Q, and Δp) from 7D to 28D were insignificant, changes in their combined effects in the form of diagnostic parameters were significant. Therefore, the functional diagnostic parameters are capable of better distinguishing changes in the hemodynamic variations, and thus, could be promising endpoints to diagnose the functionality of AVFs over time.

Effects of melatonin on cytokine release and healing of colonic anastomoses in an experimental sepsis model.

The present objective was to identify effects of early melatonin application on healing of anastomotic wound and inflammation in an experimental sepsis model. A total of 60 Wistar albino rats were divided into 2 groups. Cecal ligation puncture (CLP) and colonic resection anastomosis were performed on both the control group and the melatonin treatment group. Both groups were divided into 3 subgroups consisting of 10 rats each. One subgroup from each group underwent re-laparotomy at the 16th hour, the next on the 3rd day, and the final subgroup on the 7th day. Presently evaluated were effects of melatonin treatment of early sepsis on interleukin-6 (IL-6), interleukin-10 (IL-10), interferon gamma (INF-γ), and C-reactive protein (CRP) levels, as well as burst pressures (BPs), collagen and hydroxyproline (OHP) content of the anastomotic segments, histopathologic healing, immunohistochemical expressions, CD34, and transforming growth factor beta (TGF-ß). IL-6 and INF-γ levels of the treatment group showed a significant decrease at the 16th hour and an increase on the 3rd and 7th postoperative days. IL-10 levels were significantly higher at the 16th hour and significantly lower on the 3rd and 7th postoperative days in the control group (p<0.001 for each). The treatment group also showed significantly higher capillary permeability, fibroblast proliferation, and collagen deposits (p<0.001 for each). CD34 expression was significantly increased in the treatment group on the 7th postoperative day (p=0.005). Application of melatonin in early sepsis significantly improved colonic anastomotic healing in a rat model.

Effect of Ozone Therapy (OT) on Healing of Colonic Anastomosis in a Rat Model of Peritonitis.

Ozone is a three-oxygen molecule (O3). Ozone therapy (OT) is systematically effective when pathological inflammatory and immunologic processes are activated. Among of these conditions are wound healing, macular degeneration related to aging, and conditions that are ischemic or infectious. The aim of this study was to determine the effects of OT on wound healing of intestinal anastomosis in the presence of peritonitis in a rat model. Animal experimentation. A total of 40 Wistar albino rats were randomized into four groups (n=10) including: sham (S), peritonitis (P), ozone 0 (O0), and ozone 24 (O24). In group S, only cecal dissection was carried out. The S group had only a cecal dissection and intestinal anastomosis performed, but no peritonitis. In all other groups, cecal ligation and puncture (CLP) followed the cecal dissection to induce bacterial peritonitis. 24 h after puncture, a cecal resection and ileocolic anastomosis were performed. In group P, 24 h after CLP, a cecal resection and ileocolic anastomosis were performed and no ozone was administered. In group O0, immediately after the anastomosis, and in group O24, starting 24 hours after the anastomosis, an intraperitoneal 1 mg/kg/day ozone administration was applied for seven days. On the seventh day the animals were sacrificed, the anastomotic bursting pressures (BP) and the hydroxyproline values of the anastomotic tissues were measured, and histopathologic examination of the anastomotic segment was carried out. The highest BP was in group S, with 211±23.13 mmHg. The mean BP of group P was 141±56.25 mmHg, which was significantly lower than in the other two peritonitis groups that received ozone therapy, group O0 and O24, where it was 192±22 and 166±45 mmHg, respectively (p<0.05). The difference in the BP between groups O0 and O24 was not statistically significant (p>0.05). Histopathologic analyses of the anastomotic segments determined there was significantly more oedema and necrosis in the control group rats, and collagen deposition in the anastomotic tissue was significantly higher in the ozone-treated groups on postoperative day 7. Hydroxyproline levels were significantly higher in groups O0 and O24 compared to the peritonitis group (P). Ozone therapy has a beneficial effect on anastomotic healing of the colon in the presence of peritonitis.

Preoperative administration effect of metronidazole, ceftriaxone sodium and their combination on stenotic index of jejunal anastomotic segment of dogs

The jejunum is the longest part of the small intestine and its lumen is mainly involved in the absorption of the nutrients. The present study was conducted to evaluate the effects of metronidazole, ceftriaxoine sodium and their combination on the stenotic index of the end to end jujunal anastomotic site. To accomplish this, 20 healthy stray dogs were subjected to end to end jejunal ansastmosis. Dogs in Group A (control) underwent jejunal anstomosis with no antibiotic prophylaxis, while those in Group B received surgery and metronidazole alone at 50 mg/kg, those in Group C received ceftriaxone sodium intravenously at 30 mg/kg body weight prior to surgery and dogs in Group D were given metronidazole in combination with ceftriaxone sodium at 50 mg/kg and 30 mg/kg, respectively, 2 h before surgical intervention. No significant difference (p > 0.05) in the stenotic index was observed at 14 days after jejunal anastomosis. These findings indicate that prophylactic administration of metronidazole and ceftriaxone sodium alone or in combination had no significant effect on the stenotic index of the jejunum.

Effects of β-Glucan on Colon Anastomotic Healing in Rats Given Preoperative Irradiation

ABSTRACTBackground: Radiation therapy is an essential therapeutic modality in the management of a wide variety of tumors. We aimed to investigate the short-term effects of pelvic irradiation on the healing of colon anastomoses and to determine the potential protective effects of β-glucan in this situation. Material and Methods: Sixty Wistar albino rats were randomized into three experimental groups: a control group (n = 20), an irradiation (IR) group (n = 20), and an irradiation+β-glucan (IR+β-glucan) group (n = 20). Only segmental colonic resection and anastomosis were performed on the control group. The IR group underwent the same surgical procedure as the control group 5 days after pelvic irradiation. In the IR+β-glucan group, the same procedure was applied as in the IR group after β-glucan administration. The groups were subdivided into subgroups according to the date of euthanasia (third [n = 10] or seventh [n = 10] postoperative [PO] day), and anastomotic colonic segments were resected to evaluate bursting pressures and biochemical and histopathological parameters. Results: Bursting pressure values were significantly lower in the IR group (p < .001). Malondialdehyde (MDA) levels were significantly higher in the IR group, whereas β-glucan significantly decreased MDA levels on the third PO day (p < .001). Granulation tissue formation scores were significantly lower in the IR+β-glucan group compared with the control group and the IR group (p < .001). Conclusions: The results of this study indicate that irradiation has negative effects on the early healing of colon anastomoses. The administration of β-glucan ameliorates these unfavorable effects by altering bursting pressures and biochemical parameters.

Recipient Artery Rupture in Free Tissue Transfer in Heavily Radiated Beds

Objectives: Report a patient series of microvascular arterial rupture in fibula free flap tissue transfer for osteoradionecrosis of the mandible. 1) Evaluate the risk factors for arterial anastomotic rupture in free tissue transfer. 2) Evaluate management strategies and outcomes of these rare cases. Methods: Retrospective review of the senior surgeon’s experience at a tertiary referral center for reconstruction of mandibulectomy defects for osteoradionecrosis with free tissue transfer from 2004 through 2013. Data collection included oncologic history, surgical resection and reconstructive details, postoperative course, complications, and outcomes. Results: Over a 10-year period 38 patients underwent free fibula osseocutaneous flap reconstruction for a diagnosis of osteoradionecrosis of the mandible. There was a prevalence of 11% (4/38) that suffered delayed rupture of the recipient artery proximal to the microvascular anastomosis. Histopathology of the anastomotic segment demonstrated acute arteritis with acute inflammatory cells and pseudoaneurysm formation of the native vessel. The recipient artery of the anastomosis was the facial artery in 3 cases and the internal maxillary artery in 1 case. Timing to initial rupture ranged from 7 to 17 (median 8.5) days. In 2 of the 4 cases the anastomosis was revised, only to suffer repeat rupture. Ultimately all anastomoses required ligation, timing ranging from 10 to 20 (mean 15) days. There was 100% flap survival. Conclusions: Recipient arterial rupture is a rare occurrence, and in our experience heavily radiated tissue is the greatest risk factor. If salvage anastomosis with the same artery is undertaken, a high risk for repeat rupture exists.

English

Ureteropelvic Junction Obstruction is a disease of newborns although it is manifested in later years of life in many cases. Various modalities for management of UPJ Obstruction are available today ranging from time tested open dismembered pyeloplasty to Robot assisted laparoscopic pyeloplasty. Various minimally invasive procedures in forms of endopyelotomy (both ante-grade and retro-grade), laparoscopic pyeloplasty, and robot assisted laparoscopic pyeloplasty are available for the urologist to choose from. In less advanced centers with little or no minimally invasive procedures availability, both in terms of lack of equipment and skilled surgeon open pyeloplasty remains the gold standard in management of ureteropelvic junction obstruction. Ever since its introduction by Anderson & Hynes dismembered pyeloplasty is preferred worldwide due to its universal application and excellent success rates. Non dismembered techniques of pyeloplasty are considered useful only is specific conditions. Increased vascularity of the anastomotic segment due to incomplete resection is very helpful for better outcome. This study aims to compare the outcome of dismembered pyeloplasty with non dismembered pyeloplasty (when not contraindicated). If the results obtained are comparable then it could be assumed that when not contraindicated non dismembered pyeloplasty can be considered in place of dismembered pyeloplasty to utilize the advantage of having better blood supply at the site of anastomosis. Obstruction of the urinary tract can occur during fetal development, childhood, or adulthood. The point of obstruction can be as proximal as the calyces and as distal as the urethral meatus. The cause of obstruction may be congenital or acquired and benign or malignant. The impact of the obstruction is influenced by the extent or degree of obstruction (partial or complete, unilateral or bilateral), its chronicity (acute or chronic), the baseline condition of the kidneys, the potential for recovery, and the presence of other mitigating factors such as urinary infection. These may ultimately lead to permanent renal damage, which may result in limiting the excretion of metabolic wastes and altering water and electrolyte balance.

Özel Amino Asit Karışımının Sol Kolon Anastomozunun İyileşmesindeki Etkisi: Deneysel Çalışma

Objective: Arginine, glutamine, and Beta-hydroxy-beta-methylbutyrate were combined in a dietary supplement. This specialized amino acid mixture enhances wound collagen accumulation and increases wound healing. We aimed to investigate the effects of this special amino acid mixture on the healing process of experimental left colonic anastomosis. Material and Methods: The study included 20 adult male Wistar-Albino rats. The study group (n=10) received 685 mg/kg/day specialized amino acid mixture for 7 days until 12 h before surgery and was maintained throughout the study. Following midline laparatomy a 1-cm segment of the left colon was resected. Bowel continuity was restored with an end-to-end anastomosis. The animals were re-anesthetized on day 7 after the operation and anastomotic bursting pressure was measured by passing a catheter per anum up to the area of anastomosis. Anastomotic segments were removed en bloc and were vertically divided into two. One was used for hydroxyproline measurement and the other for histopathological examination. Abramov's histologic scoring system was used in this study. Results: The hydroxyproline levels and bursting pressures in the study group were superior compared to the control group. Collagen deposition and reepithelization scores of the study group were higher than that of the control group. Conclusion: Results of the present study indicates that significantly enhancing the anastomotic bursting pressure, hydroxyproline level and collagen deposition may improve anastomosis healing.

Effects of preoperative irradiation using fractioned electron beam on the healing process of colocolonic anastomosis in rats undergoing early and late surgical intervention

To investigate the effects of preoperative fractioned irradiation using an electron beam on the healing process of colocolonic anastomoses in rats that underwent early and late surgical intervention. Thirty Wistar rats, distributed as follows: group A (surgery only), group B (fractionated irradiation for 30 days (if), surgery seven days after the end of it), group C (if for 30 days, and surgery after 30 days of termination). On the seventh postoperative day the anastomotic segment analysis was taken, using tension tests, histology and collagen deposition evaluation by computerized analysis. Regarding the tension resistance of the anastomosis, there were no statistical differences (p=0.42). However, a significant increase in cells number in the inflammatory infiltrate in the group with a longer interval between surgery and pre op radiation (p<0.05). The collagen concentration had no significant variance. The irradiation in divided doses increased local inflammatory cellularity when the surgery was performed later. This result did not affect the increase of complications, nor on the local concentration of collagen, achieving similar clinical outcomes.

Effects of Thyroid Hormone Supplementation on Anastomotic Healing After Segmental Colonic Resection

Alterations of thyroid hormones in colorectal surgery were previously studied. The aim of the present study was to determine the effects of triiodothyronine (T3) supplementation on anastomotic healing after segmental colectomy. Thirty male Wistar albino rats were divided into sham (n = 6), control (n = 12), and experimental (n = 12) groups. Sham group rats were immediately sacrificed after segmental colonic resection. Control and experimental group rats underwent resection and anastomosis. Experimental group rats received a single dose of T3 (400 μg/100 g) in postoperative day 1. Half of both control and experimental group rats were sacrificed on postoperative d 3 and the remaining half were sacrificed on postoperative d 7. Hydroxiproline (HP), myeloperoxidase (MPO), thyroid stimulating hormone (TSH), free T3 (FT3), and free thyroxine (FT4) levels, bursting pressure, and histologic analyses of the anastomotic segments were compared. FT3 levels significantly decreased in control groups rats compared with the sham group (P < 0.01). However, T3 hormone given rats had no decline in FT3 levels. Anastomotic bursting pressure was significantly higher in the experimental group rats on postoperative d 7 (P = 0.015). Histopathologic analyses of the anastomotic segments determined significantly more severe edema and necrosis in control group rats (P < 0.05). Collagen deposition in the anastomotic tissue was significantly higher in experimental group rats on postoperative d 7 (P = 0.015). Anastomosis after colon resection is associated with decreased FT3 level. T3 supplementation ameliorates the reduction in FT3 and seems to provide constructive therapeutic effects on anastomotic healing.

Impact of Different Crystalloid Volume Regimes on Intestinal Anastomotic Stability

Anastomotic insufficiency still remains an unsolved problem in digestive surgery. Little clinical data, regarding the impact of perioperative volume management exist, which suggest lower complication rates in intestinal surgery under restrictive volume regimens. The aim of our study was to investigate the effect of the extent of intraoperative fluid administration with crystalloids on the stability of intestinal anastomoses. Twenty-one rats were randomly assigned to 3 experimental groups (n = 7 rats/group): control group CO (9 mL kg h crystalloid infusion), volume restriction group V (-) (3 mL kg h), and animals with volume overload V (+) (36 mL kg h). After midline incision, all animals received the corresponding infusion for a 30-minute period. Infusion was continued for further 30 minutes whereas an end-to-end small bowel anastomosis was performed 15 cm proximal to the Bauhin valve with 8 nonabsorbable interrupted inverting sutures. At reoperation on the 4th postoperative day, the anastomotic segment was dissected and the bursting pressure [mmHg] was measured. As a second parameter for the quality of anastomotic healing, hydroxyproline concentration was examined with a spectrophotometric method [microg/g dry tissue]. Histologically, structural changes of the anastomotic segments were assessed by 2 pathologists. Data are given as mean +/- SEM. Anastomotic insufficiency was not seen in all animals. Bursting pressure of CO animals was 102 +/- 8 mmHg. Bursting pressure was lowest in V (+) with high volume exposure at 77 +/- 6 mmHg and significantly lower than V (-) (112 +/- 9 mmHg; P = 0.01) whereas the difference compared with the CO group did not reach significant values. Hydroxyproline concentration in V (+) (64.4 microg/g dry tissue +/- 7.7) was significantly lower compared with V (-) (91.7 microg/g dry tissue +/- 9.1) animals (P < 0.05). In all animals with volume overload a marked submucosal edema was found. We could demonstrate for the first time in a systematic investigation, that the quantity of crystalloid infusion, applied intraoperatively, has a significant impact on functional (bursting pressure) and structural (hydroxyproline) stability of intestinal anastomoses in the early postoperative period. Because the stability and quality of an intestinal anastomosis have an impact on insufficiency rates, it should be noted that volume overload may have deleterious effects on anastomotic healing and postoperative complications in digestive surgery, possibly because of a marked bowel wall edema.

Small intestinal submucosa for reinforcement of colonic anastomosis

Different materials have been evaluated for anastomotic reinforcement to prevent gastrointestinal anastomotic leakage. In this experimental study, small intestinal submucosa (SIS) was tested as a sealing for stapled colonic anastomosis in a porcine model. The aims of this study were to determine the macroscopic and microscopic outcomes and to evaluate the safety and feasibility of applying SIS for anastomotic sealing. Circular stapled anastomoses were performed in 18 pigs. Standard anastomosis in the control group (n = 8) was compared to an SIS-sealed anastomosis in the study group (n = 10). After 30 days, anastomotic segments were examined for macroscopic and microscopic regeneration and their resistance to mechanical stress. Furthermore, animal survival and clinical course were evaluated. None of the animals developed anastomotic leakage, intraabdominal abscess, or peritonitis. Shrinkage of SIS was evident in nine of ten animals. Encapsulation and displacement of the SIS patches were seen in two animals. Quantity of anastomotic granulation tissue and rate of complete mucosal coverage of anastomotic line were increased in SIS-sealed anastomoses without reaching significance. Moreover, no significant differences were found in the rate of survival of the animals, anastomotic stricture formation, intraabdominal adhesions, anastomotic bursting pressure, and microscopic healing parameters of the anastomosis between stapled colonic standard anastomosis and anastomosis protected by SIS. The results of this study indicate a safe use of SIS for anastomotic reinforcement in a porcine model. Adverse effects like strictures, increased adhesions, and anastomotic abscesses were absent. Promoting effects on colonic wound healing by SIS were microscopically evident. The results argue for a careful clinical evaluation in humans.

Effect of early preoperative 5-fluorouracil on the integrity of colonic anastomoses in rats

To determine the effect of chemotherapy on wound healing by giving early preoperative 5-fluorouracil (5-FU) to rats with colonic anastomoses. Sixty Albino-Wistar male rats (median weight, 235 g) were used in this study. The rats were fed with standard laboratory food and given tap water ad libitum. The animals were divided into three groups: Group 1: Control group (chemotherapy was not administered), Group 2: Intraperitoneally (i.p.) administered 5-FU group (chemotherapy was administered i.p. to animals at a dose of 20 mg/kg daily during the 5 d preceding surgery), Group 3: Intravenously (i.v.) administered 5-FU group. Chemotherapy was administered via the penil vein, using the same dosing scheme and duration as the second group. After a 3-d rest to minimize the side effects of chemotherapy, both groups underwent surgery. One centimeter of colon was resected 2 cm proximally from the peritoneal reflection, then sutured intermittently and subsequently end-to-end anastomosed. In each group, half the animals were given anaesthesia on the 3rd postoperative (PO) day and the other half on the 7th PO day, for in vivo analytic procedures. The abdominal incisions in the rats were dissected, all the new and old anastomotic segments were clearly seen and bursting pressures of each anastomotic segment, tissue hydroxyproline levels and DNA content were determined to assess the histologic tissue repair process. When the i.v. group was compared with the i.p. group, bursting pressures of the anastomotic segments on the 3rd and 7th PO days, were found to be significantly decreased, hydroxyproline levels at the anastomotic segment on the 7th PO day were significantly decreased (P < 0.01). In this study, we conclude that early preoperative 5-FU, administered i.v., negatively affects wound healing. However, i.p. administered 5-FU does not negatively affect wound healing.

The Pig as an Experimental Model for Colonic Healing Study of Leakage and Ischemia in Colonic Anastomosis

Background: The object of this experimental study was to develop a model of anastomotic failure due to primary leakage and ischemia in porcine large bowel anastomosis. Methods: End-to-end anastomosis was constructed at descending colon in 12 pigs. The pigs were randomly divided into three groups. In Group A, the anastomosis was applied with a leak of 18 mm. In Group B, in addition to primary leakage, an artificial ischemia of the proximal anastomotic bowel segment was created by ligation of supplying vessels over 5 cm. In Group C, an artificial ischemia was created in the same manner at the proximal and distal anastomotic segment and the anastomosis was applied with an intentional leakage as in Groups A and B. The animals were sacrificed immediately in case of clinical signs of anastomotic dehiscence, sepsis, peritonitis, or ileus. The animals were sacrificed on day 28. The peritoneal cavity was examined for peritonitis, anastomotic wound dehiscence, and pericolic abscess formation. Results: Distinct fibrinous coverings and adhesions at the anastomotic area were found in all animals. In cases of primary leakage without ischemia, only one of the four animals developed abscess at anastomotic side with clinical sepsis. In cases of primary leakage with ischemia of the proximal anastomotic bowel segment, one of the four animals presented generalized peritonitis with sepsis. In Group C, there were no signs of leakage or peritonitis, although three of the four animals developed colonic ileus due to obturation of the colonic lumen by a clot of necrotic bowel wall. Conclusion: Large anastomotic dehiscence and local ischemia of the bowel wall are not reliable factors for the development of intra-abdominal abscess, peritonitis, or sepsis in the pig model.

Ultrastructural view of colon anastomosis under propolis effect by transmission electron microscopy

To evaluate the effect of propolis administration on the healing of colon anastomosis with light and transmission electron microscopes. Forty-eight Wistar-Albino female rats were divided into two groups and had colon resection and anastomosis. In group I, rats were fed with standard rat chow pre- and postoperatively. The rats in group II were fed with standard rat chow and began receiving oral supplementation of propolis 100 mg/kg per day beginning 7 d before the operation and continued until they were sacrificed. Rats were sacrificed 1, 3, 7 and 14 d after operation, and anastomotic bursting pressures measured. After the resection of anastomotic segments, histopathological examination was performed with light and transmission electron microscopes by two blinded histologists and photographed. The colonic bursting pressures of the propolis group were statistically significantly better than the control group. Ultrastructural histopathological analysis of the colon anastomosis revealed that propolis accelerated the phases of the healing process and stimulated mature granulation tissue formation and collagen synthesis of fibroblasts. Bursting pressure measurements and ultra structural histopathological evaluation showed that administration of propolis accelerated the healing of colon anastomosis following surgical excision.

Internal Herniation Through the Mesenteric Opening After Laparoscopy-assisted Right Colectomy: Report of a Case

We discuss a rare complication in a patient who underwent laparoscopic colectomy. A 69-year-old woman underwent laparoscopy-assisted right colectomy for cancer of the ascending colon. Two months after the operation, bowel obstruction developed. Decompression with a long intestinal tube failed to resolve the obstruction. Thus, surgery was performed. Abdominal exploration revealed a strangulated ileal loop caused by herniation through the mesenteric opening at the anastomotic site. The mesenterium had not been sutured during the previous operation. The anastomotic segment had twisted semicircularly and adhered to the retroperitoneum, so the mesenteric opening had narrowed.

Does 16-MDCT angiography scanning direction affect image quality of coronary artery bypass grafts and the native coronary arteries?

To assess the impact of scanning direction on the image quality of coronary artery bypass grafts (CABGs), native coronary arteries (NCAs) were examined by electrocardiographically (ECG) gated 16-row multidetector computed tomography (16-MDCT). Eighty-two patients with 209 grafts were studied by 16-MDCT. Forty-one patients with 111 grafts were scanned craniocaudally. Forty-one patients with 98 grafts were scanned caudocranially. CABG, native coronary arteries were examined in four (proximal, middle, distal, distal anastomoses), three (proximal, middle, distal) segments, respectively. Subjective image quality on a four-point scale was calculated for segments. Scores of groups were compared. Results Image quality scores of proximal, distal segments of the right coronary artery (RCA) were better in caudocranially scanned group (P<0.05). When we subgrouped patients according to initial heart rates (IHR) (group 1, <65 beats/min; group 2, > or =65 beats/min), there was no statistical significance between image quality scores of coronary arteries, CABG when IHR was <65 beats/min in groups regardless of scanning direction. Scores of anastomotic segment of CABG to RCA, middle segments of circumflex coronary artery, proximal and distal segments of RCA in caudocranially scanned group were better when the IHR is > or =65 beats/min compared with the craniocaudally scanned group. When the IHR of the patient is > or =65 beats/min, performing ECG-gated 16-MDCT angiography in the caudocranial direction provides better image quality for evaluation of coronary arteries and CABGs.