Complication Of Abdominal Surgery Research Articles

Fístulas enterocutáneas- manejo clínicoquirúrgico

Las fístulas entero cutáneas se han vuelto complicaciones prevalentes de los enfermos atendidos por los servicios quirúrgicos de los hospitales, principalmente después del abordaje operatorio del abdomen con intervención directa o no del tracto gastrointestinal, con la consiguiente morbi-mortalidad alarmante. Las fístulas enterocutáneas son una complicación de la cirugía abdominal, aunque pueden ocurrir por otras causas como, la enfermedad inflamatoria intestinal. Es un cuadro relativamente raro, se asocia con una morbi-mortalidad elevada, principalmente en relación con otras complicaciones asociadascomo la sepsis, y plantea un importante reto a cirujanos, gastroenterólogos y otros profesionales. El cierre espontáneo ocurre en un 30% de los casos, siendo necesario recurrir a la cirugía cuando fracasa el tratamiento conservador, que es el indicado en primera instancia. El diagnóstico precoz, la estabilización clínica inicial con medidas de soporte agresivas y la adecuadatemporización de la cirugía, en caso necesario, condicionan de forma muy significativa el pronóstico. La desnutrición es frecuente, la forma tradicional de soporte nutricional es la nutrición parenteral, y aunque la restricción de la ingesta oral y el reposo intestinal son principios que se aplican en forma frecuente, no hay evidencia de que esta práctica produzca un aumento en la tasa de cierre de la fístula.

Variations of the Branches of the Coeliac Trunk: a Case Report

The hepatic, splenic and left gastric arteries are considered as the “main classic branches” of the coeliac trunk. We reported two cases of coeliac trunk. Left inferior phrenic artery arose directly from coeliac trunk and accessory hepatic artery arose from common hepatic artery. In our opinion; arterial variations should not be ignored during abdominal operative procedures. Complications in abdominal surgeries could be avoided with the accurate knowledge of the anatomical variations of coeliac trunk. DOI: http://dx.doi.org/10.3126/ajms.v2i3.4248 Asian Journal of Medical Sciences 2 (2011) 148-150

Variations of the Branches of the Coeliac Trunk: a Case Report

The hepatic, splenic and left gastric arteries are considered as the “main classic branches” of the coeliac trunk. We reported two cases of coeliac trunk. Left inferior phrenic artery arose directly from coeliac trunk and accessory hepatic artery arose from common hepatic artery. In our opinion; arterial variations should not be ignored during abdominal operative procedures. Complications in abdominal surgeries could be avoided with the accurate knowledge of the anatomical variations of coeliac trunk. DOI: http://dx.doi.org/10.3126/ajms.v2i3.4248 Asian Journal of Medical Sciences 2 (2011) 148-150

Biologic treatment or immunomodulation is not associated with postoperative anastomotic complications in abdominal surgery for Crohn's disease

Objectives.There are concerns that biologic treatments or immunomodulation may negatively influence anastomotic healing. This study investigates the relationship between these treatments and anastomotic complications after surgery for Crohn's disease. Patients and methods.Retrospective study on 417 operations for Crohn's disease performed at four Danish hospitals in 2000–2007. Thirty-two patients were preoperatively treated with biologics and 166 were on immunomodulation. In total, 154 were treated with corticosteroids of which 66 had prednisolone 20 mg or more. Results.Anastomotic complications occurred at 13% of the operations. There were no difference in patients on biologic treatment (9% vs. 12% (p = 0.581)) or in patients on immunomodulation (10% vs. 14% (p = 0.263)). Patients on 20 mg prednisolone or more had more anastomotic complications (20% vs. 11% (p = 0.04)). Anastomotic complications were more frequent after a colo-colic anastomosis than after an entero-enteric or entero-colic (33% vs. 12% (p = 0.013)). Patients with anastomotic complications were older (40 years vs. 35 years (p = 0.014)), had longer disease duration (7.5 years vs. 4 years (p = 0.04)), longer operation time (155 min vs. 115 min (p = 0.018)) and more operative bleeding (200 ml vs. 130 ml (p = 0.029)). Multivariate analysis revealed preoperative treatment with prednisolone 20 mg or more, operation time and a colo-colic anastomosis as negative predictors of anastomotic complications. Conclusions.Preoperative biologic treatment or immunomodulation had no influence on anastomotic complications. The study confirms previous findings of corticosteroids and a colo-colic anastomosis as negative predictors and also that surgical complexity, as expressed by bleeding and operation time, may contribute to anastomotic complications.

Complications after laparoscopic gastric banding in own material.

IntroductionComplications after bariatric procedures are the most difficult to diagnose among all complications in abdominal surgery. Furthermore, they are extremely difficult to treat conservatively and surgically. Laparoscopic treatment of complications after bariatric procedures requires great skills. Complications after laparoscopic adjustable gastric banding (LAGB) are remarkably diverse.AimPresentation of complications after LAGB in our own material.Material and methodsFrom 2005 to 2010, in the 1st Department of General and Endocrine Surgery, in 110 patients adjustable gastric banding was applied. All procedures were conducted laparoscopically. The group consisted of 76 women (69.1%) and 34 men (30.9%). The average age of women was 37.7 ±13.80 years old. The average age of men was 38.9 ±11.50 years old. The average body mass was 128.5 ±24.35 kg for women and 125.4 ±23.60 kg for men. The average body mass index (BMI) for women was 44.08 ±3.03 kg/m2 and for men 43.66 ±2.90 kg/m2. The average waist circumference was 113.5 ±12.75 cm in women and for men it was 124.40 ±14.8 cm.ResultsIn the analysed material, which consisted of 110 patients after LAGB, 36% developed at least 1 complication. Among early complications, injury of diaphragm, pneumothorax, pleural empyema, gastric perforation and thrombophlebitis were observed. Among late complications, oesophagitis, infections around the port, migration of the gastric band into the gastric lumen, band slippage, vomiting and lack of body mass loss were observed. The most common reasons for the removal of the band were band slippage, its migration to the gastric lumen and extension of the gastric reservoir.ConclusionsThe LAGB is a relatively easy procedure with a short time of performance and short hospitalization. However, it can bring the risk of intraoperative, perioperative and late complications which require surgical intervention. The present research results are comparable to world data. Complications after LAGB were observed the most frequently in the first years of application of the procedure.

Does obesity complicate perioperative course in patients undergoing abdominal hysterectomy?

Obesity is traditionally believed to increase the incidence of perioperative complications in abdominal surgery. Recently this paradigm has been challenged mainly by observations from surgical specialties other than gynecology. Our aim was to assess the impact of obesity on perioperative course in women undergoing total abdominal hysterectomy. We analyzed medical charts of 126 patients who underwent total abdominal hysterectomy for benign gynecological conditions through a low transverse incision in the Department of Obstetrics and Gynecology of the Provincial Specialist Hospital in Czestochowa, Poland. Perioperative course was compared between obese [n = 55; body mass index (BMI) ≥ 30 kg/m(2): mean 32.6 ± 3.2 kg/m(2)] and non-obese patients (n = 71; mean BMI 24.3 ± 3 kg/m(2)). The mean operative time in obese women was significantly prolonged (112 ± 32 vs. 100 ± 31 min, P = 0.036). However, complication rates and other perioperative outcomes were comparable between the groups. In our study, mild obesity does not significantly affect the perioperative course in women undergoing total abdominal hysterectomy.

Development of a clinical trial to determine whether watchful waiting is an acceptable alternative to surgical repair for patients with oligosymptomatic incisional hernia: study protocol for a randomized controlled trial

BackgroundIncisional hernia is a frequent complication in abdominal surgery. This article describes the development of a prospective randomized clinical trial designed to determine whether watchful waiting is an acceptable alternative to surgical repair for patients with oligosymptomatic incisional hernia.Methods/DesignThis clinical multicenter trial has been designed to compare watchful waiting and surgical repair for patients with oligosymptomatic incisional hernia. Participants are randomized to watchful waiting or surgery and followed up for two years. The primary efficacy endpoint is pain/discomfort during normal activities as a result of the hernia or hernia repair two years after enrolment, as measured by the hernia-specific Surgical Pain Scales (SPS). The target sample size of six hundred thirty-six patients was calculated to detect non-inferiority of the experimental intervention (watchful waiting) in the primary endpoint. Sixteen surgical centers will take part in the study and have submitted their declaration of commitment giving the estimated number of participating patients per year. A three-person data safety monitoring board will meet annually to monitor and supervise the trial.DiscussionTo date, we could find no published data on the natural course of incisional hernias. To our knowledge, watchful waiting has never been compared to standard surgical repair as a treatment option for incisional hernias. A trial to compare the outcome of the two approaches in patients with oligosymptomatic incisional hernias is urgently needed to provide data that can facilitate the choice between treatment options. If watchful waiting was equal to surgical repair, the high costs of surgical repair could be saved. The design for such a trial is described here.This multicenter trial will be funded by the German Research Foundation (DFG). The ethics committee of the Charité has approved the study protocol. Approval has been obtained from ten study sites at time of this submission. The electronic Case Report Forms have been created. The first patient was to be randomized November 14th, 2011. An initiation meeting took place in Berlin January 9th, 2012.Trial RegistrationClinicalTrials.gov: NCT01349400

Analogi puryn jako czynnik ryzyka wystąpienia powikłań pooperacyjnych u osób z chorobą Leśniowskiego-Crohna

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Borycka-Kiciak K, Kiciak A, Janaszek Ł, Jaworski P, Tarnowski W. Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease. Gastroenterology Review/Przegląd Gastroenterologiczny. 2012;7(1):13-19. doi:10.5114/pg.2012.27217. APA Borycka-Kiciak, K., Kiciak, A., Janaszek, Ł., Jaworski, P., & Tarnowski, W. (2012). Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease. Gastroenterology Review/Przegląd Gastroenterologiczny, 7(1), 13-19. https://doi.org/10.5114/pg.2012.27217 Chicago Borycka-Kiciak, Katarzyna, Adam Kiciak, Łukasz Janaszek, Paweł Jaworski, and Wiesław Tarnowski. 2012. "Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease". Gastroenterology Review/Przegląd Gastroenterologiczny 7 (1): 13-19. doi:10.5114/pg.2012.27217. Harvard Borycka-Kiciak, K., Kiciak, A., Janaszek, Ł., Jaworski, P., and Tarnowski, W. (2012). Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease. Gastroenterology Review/Przegląd Gastroenterologiczny, 7(1), pp.13-19. https://doi.org/10.5114/pg.2012.27217 MLA Borycka-Kiciak, Katarzyna et al. "Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease." Gastroenterology Review/Przegląd Gastroenterologiczny, vol. 7, no. 1, 2012, pp. 13-19. doi:10.5114/pg.2012.27217. Vancouver Borycka-Kiciak K, Kiciak A, Janaszek Ł, Jaworski P, Tarnowski W. Purine analogues as a risk factor of postoperative complications in abdominal surgery for Crohn’s disease. Gastroenterology Review/Przegląd Gastroenterologiczny. 2012;7(1):13-19. doi:10.5114/pg.2012.27217.

Polymixin-B hemoperfusion in a case intolerant to conventional antibiotic therapy

In this study we document how it was possible to resolve the septic complications of abdominal surgery, subjecting a patient severely allergic to intravenous antibiotics. We performed the hemoperfusion with polymyxin-B columns (PMX-DHP), guiding the therapy by assaying endotoxin activity and evaluating the clinical status of the patient after each session of PMX-DHP. The stabilization of hemodynamic and inflammatory frameworks were immediately observed after the PMX-DHP. The patient could be safely discharged five days after the discontinuation of the therapy. Our findings confirms data already published in literature concerning the effectiveness of PMX-DHP.

Chylous ascites caused by resection of a choledochal cyst

Chylous ascites is a rare complication of abdominal surgery in children. Particularly, reports of postoperative chylous ascites are rare. This report describes the very rare case of a 10-month-old girl complicated by chylous ascites after resection of a choledochal cyst with a Roux-en-Y hepaticojejunostomy, who was successfully treated medically. To date, we have found a few cases of postoperative chylous ascites in the paediatric literature. To the best of our knowledge, this is the first report of chylous ascites after the resection of a choledochal cyst in a child who was successfully treated solely by no fasting. No fasting might be a therapeutic option of paediatric postoperative chylous ascites after the resection of a choledochal cyst if the outflow volume of chylous ascites is small.

Elevated serum C-reactive protein as a predictive factor for anastomotic leakage in colorectal surgery

BackgroundC-reactive protein (CRP) has been used as an indicator of postoperative complications in abdominal surgery. Its short half-life makes it a reliable marker of the systemic inflammatory response secondary to a surgical procedure or to the appearance of complications, rapidly returning to normal values with the recovery of the patient. AimTo demonstrate the value of sequential serum determinations of postoperative C-reactive protein (CRP) and white blood cell counts (WBC) in the identification of increased risk of anastomotic leakage after colorectal surgery. MethodsWe reviewed the daily postoperative serum CRP and white blood cell counts in 173 patients who underwent surgery for colorectal disease with anastomosis, between January 2008 and October 2009. Patients with anastomotic leakage (Group A, n = 24) were compared to patients without leakage (Group B, n = 149). Patients with ongoing infections before surgery or with acquired postoperative infections other than leakage were excluded. Mean pre- and postoperative values of CRP and WBC were compared. ResultsThe diagnosis of anastomotic leakage was made between the 4th and 11th postoperative day (POD; mean 7th POD). The daily average values of serum CRP were significantly higher in group A starting at the 2nd POD and remained significantly elevated until the diagnosis of leakage (p = 0.003). The cut-off value of 140 mg/L on the 3rd POD maximized the sensitivity (78%) and specificity (86%) of serum CRP in assessing the risk of leakage. Comparison of postoperative serum WBC values did not show any significant differences between the two groups until the 6th POD. ConclusionAccording to these results, an early and persistent elevation of CRP after colorectal surgery with anastomosis, is a marker of anastomotic leakage. A cut-off value > 140 mg/L on POD3 maximizes sensitivity and specificity.

Splenic infarction following conventional open gastrectomy in patients with gastric malignancy: a CT-based study

The aim of this CT-based study was to investigate the frequency of splenic infarction (SI) following conventional open gastrectomy performed for gastric malignant neoplasms. 20 patients who underwent subtotal or total gastrectomy, omentectomy, and D2 lymph node dissections preserving the spleen for gastric malignant neoplasms were retrospectively reviewed. Patients with postoperative CT scans within 3 months were enrolled in this study. CT imaging was performed with a 64-row multidetector CT scanner. Abdominal CT scan with precontrast and postcontrast portal phase images was performed on 19 of the patients, while pulmonary CT angiography was performed on 1 patient for chest pain. Second postoperative control abdominal CT images were also present for 3 of the 5 patients with SI. These examinations were also reviewed for the evolution of the SI's. SI was detected in 5 of the patients (25%) at a postoperative early stage. A single infarct area was detected in 4 of the 5 patients while two distinct infarct areas were present in one patient. The infarct areas in two patients disappeared on the second postoperative control CT. A decrease in the size of the SI area in 1 patient was also detected on the second postoperative control CT scan. The frequency of SI as a complication of abdominal surgeries tends to increase in CT-based studies. We have detected the highest frequency in the literature and suggest that SI, especially when accompanying D2 lymphadenectomy, should be included in the list of early stage gastrectomy complications.

Depiction of Variants of the Portal Confluence Venous System Using Multidetector Row CT: Analysis of 916 Cases

Detailed knowledge of the venous mesenteric system is important for gastrointestinal surgery, particularly for transplantation planning and surgery and for the comprehension of perioperative complications that may influence patient outcome. Data about the mesenteric venous anatomy in the literature varies substantially. The purpose of this study was to categorize venous mesenteric variants and to determine their incidence. We included 916 patients requiring diagnostic abdominal CT in the portal venous phase. The mesenteric vein anatomy was categorized as follows: 1. the inferior mesenteric vein (IMV) enters the splenic vein (SV); 2. the IMV enters into the angle of the confluence of the SV and superior mesenteric vein (SMV) forming the portal vein (PV); 3. the IMV enters the SMV; 4. seven rare variants. We measured the diameters of the veins and distances from the confluence to the IMV origins. The frequency of variants was: 1. 37.6%, 2. 28.8%; 3. 19.2%. The rare variants totaled 14.4%. The average vessel diameters measured in cm: PV 1.48; SV 1.02; SMV 1.2; IMV 0.5. The mean IMV entering distances were 1.66 cm in variant 1 and 0.75 cm in variant 3. The three common variants (1, 2 and 3) are the most relevant ones. 14.4% of patients had different anatomic variants. The variability of the mesenteric venous system was higher than previously published. Knowledge of rare variants is important to avoid complications in abdominal surgery.

Malnutrition and Postoperative Complications in Abdominal Surgery

Rosa, Fausto MD; Bossola, Maurizio MD; Pacelli, Fabio MD; Alfieri, Sergio MD; Doglietto, Giovanni Battista MD Author Information

Malnutrition and Postoperative Complications in Abdominal Surgery

Malnutrition and Postoperative Complications in Abdominal Surgery

Postoperative complications after abdominal surgery in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease is a well-known independent risk factor for the development of postoperative pulmonary and cardiac complications after thoracic or nonthoracic surgery. We aimed to determine the risk factors and complications of abdominal surgery in chronic obstructive pulmonary disease patients. Thirty-two patients diagnosed with chronic obstructive pulmonary disease out of 89 patients who underwent abdominal surgery at Zonguldak Karaelmas University Medical School Hospital enrolled in the study. Pulmonary and cardiac complication ratios were found high in chronic obstructive pulmonary disease patients. Postoperative pulmonary and cardiac complications were documented in 21.8% and 28.1% of chronic obstructive pulmonary disease patients respectively. There were no differences in terms of complications, according to the severity of the disease in chronic obstructive pulmonary disease patients. While smoking and age did not effect the postoperative complications in chronic obstructive pulmonary disease patients, bronchodilator use increased postoperative cardiac risks. We found that laparoscopic surgery reduced the risk for postoperative pulmonary complications compared with open surgical procedures. No differences were found in terms of complication regarding to the type of incision and the duration of surgery. The patients with chronic obstructive pulmonary disease had high ratio of the pulmonary and cardiac complications. The complication rate was higher for surgical sites closer to the diaphragm such as the upper abdomen. Laparoscopy will reduce the risk for postoperative pulmonary complications compared with open surgical procedures. Based on our preliminary data and considering the lack of controlled trials, bronchodilators should be used with great caution particularly in the individuals with chronic obstructive pulmonary disease and cardiac comorbidity.

Gastroparesis: Approach, Diagnostic Evaluation, and Management

Gastroparesis is a chronic motility disorder of the stomach that involves delayed emptying of solids and liquids, without evidence of mechanical obstruction. Although no cause can be determined for the majority of cases, the disease often develops as a complication of abdominal surgeries or because of other underlying disorders, such as diabetes mellitus or scleroderma. The pathophysiology behind delayed gastric emptying is still not well-understood, but encompasses abnormalities at 3 levels--autonomic nervous system, smooth muscle cells, and enteric neurons. Patients will often cite nausea, vomiting, postprandial fullness, and early satiety as their most bothersome symptoms on history and physical examination. Those that present with severe disease may already have developed complications, such as the formation of bezoars or masses of undigested food. In patients suspected of gastroparesis, diagnostic evaluation requires an initial upper endoscopy to rule out mechanical causes, followed by a gastric-emptying scintigraphy for diagnosis. Other diagnostic alternatives would be wireless capsule motility, antroduodenal manometry, and breath testing. Once gastroparesis is diagnosed, dietary modifications, such as the recommendation of more frequent and more liquid-based meals, are encouraged. Promotility medications like erythromycin and antiemetics like prochlorperazine are offered for symptomatic relief. These agents may be frequently changed, as the right combination of effective medications will vary with each individual. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, are considered. Future areas of research are based on current findings from clinical studies. New medications, such as hemin therapy, are emerging because of a better understanding of the pathophysiology behind gastroparesis, and present treatment options, such as gastric electric stimulation, are evolving to be more effective. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future.

Historical Perspectives in the Care of Patients with Enterocutaneous Fistula

Evidence can be found throughout surgical history of how devastating an enterocutaneous fistula (ECF) can be for both patient and surgeon. From antiquity, this complication of abdominal surgery, malignancy, radiation, trauma, or inflammatory processes has been a significant challenge to surgeons due to high associated mortality and significant morbidity. An ECF causes dehydration, malnutrition, skin excoriation, and sepsis, and has profound psychological effects on the patient. Recent mortality rates of patients suffering an ECF approach 20%. The authors illustrate the history of management of patients with ECF and discuss advances in perioperative care including parasurgical care, nutrition, wound care, and the history of surgical techniques.

Oligosymptomatic vs. symptomatic incisional hernias—who benefits from open repair?

Incisional hernias are one of the most often complications in abdominal surgery and therefore present a significant surgical and socioeconomic problem. To date, incisional hernias are always an indication for surgery, regardless of the patient's symptoms. However, it remains unclear to what extent the surgery actually results in symptomatic improvement and whether a relevant risk of incarceration exists. The purpose of this study was to investigate the motivation that led to incisional hernia repairs and whether patients benefit from surgery with regard to pain and subjective criteria. This prospective study included patients who underwent open abdominal incisional hernia repair using mesh implantation. Data collection was done preoperatively and 6 months postoperatively. The intensity of pain was evaluated using the Numeric Analog Scale (NAS). Patients were divided according to their preoperative level of pain into oligosymptomatic (NAS 0-3) and symptomatic (NAS 4-10) groups, and the postoperative outcome of both groups was compared. Ninety patients were prospectively enrolled: 45 males (50.0%) and 45 females (50.0%); 43 patients (47.8%) were oligosymptomatic preoperatively, while 47 patients (52.2%) reported relevant pain. The most frequent motivation for surgery named by the oligosymptomatic patients was fear of incarceration (79.1%), while the symptomatic patients mostly mentioned pain (76.6%). At 6 months postoperatively, significantly more oligosymptomatic patients complained of relevant pain (p < 0.001). In the symptomatic patient group, there was a significant reduction in relevant pain (p < 0.001). At that time, the level of relevant pain was comparable in both groups (33.3% versus 35.6%). Seven of 87 patients (8.0%) experienced recurrence within 6 months. Three patients with acute incarceration were treated with emergency repair (3.2%). In patients with oligosymptomatic incisional hernias, fear of incarceration is the most frequent motivation for surgical treatment, even though the actual risk of incarceration seems to be rather low. If the incisional hernia causes relevant discomfort preoperatively, the surgery provides significant relief. In contrast, there is no improvement regarding pain in the oligosymptomatic patient group. This leads to the conclusion that, in the case of oligosymptomatic incisional hernias, the general indication for surgical revision should be viewed critically.

Erythropoietin (EPO) Influences Colonic Anastomotic Healing in a Rat Model by Modulating Collagen Metabolism

Anastomotic failure is one of the most frequent complications in abdominal surgery. During anastomotic healing. the strength of the intestinal tissue nearby is closely related to the accumulation of collagen in interlinked scar tissue. This in turn is influenced, among other things, by single groups of matrixmetalloproteinases, especially collagenases (MMP-1, -8, and -13) and gelatinases (MMP-2 and -9). EPO is known to induce the expression of tissue-inhibitor-of-matrixmetalloproteinases-1 (TIMP-1) and thereby to down-regulate MMPs. We used a rat as an experimental model and applied a high dose of EPO (5U/g BW s.c.), one dose 24 h before operation (as pre-conditioning) and one dose directly after performing a colonic anastomosis. After 3 and after 5 d, respectively, immunohistochemical stainings for MMP-2, -8, and -9 as well as TIMP-1 were carried out and evaluated semiquantitatively for each layer of the colonic wall. Sirius-red staining and cross-polarization microscopy were evaluated and the collagen I/III ratio calculated. Anastomotic and colonic tissue distal to the anastomosis were used to determine collagen content. We found increased bursting pressure 5d post-surgery after applying erythropoietin. It was thus shown that EPO influences collagen metabolism and changes the collagen I/III ratio in the colon distal to the anastomosis. The evaluation of immunohistochemistry did not show the expected ubiquitous up-regulation of TIMP-1 and down-regulation of MMPs. Nevertheless, correlations between TIMP-1, MMP-8, and collagen I/III ratio could only be established after the application of EPO. Contrary to our hypothesis, the picture of TIMP-1 and of the regulation of the MMPs after the application of EPO is not as clear as expected. EPO improves anastomotic bursting strength and the correlation of TIMP-1, MMP-8, and collagen type I/III ratio can only be seen after the application of EPO.