BACKGROUND: The aim of our study was to establish whether ischemic preconditioning (IPC) directly before performing a small bowel anastomosis has an effect on anastomotic stability and healing. MATERIAL AND METHODS: Forty male Wistar rats were randomized to five groups: control (CO, n = 8) with preparation of the superior mesenteric artery (SMA) but without IPC. IPC groups had different intervals of ischemia (occlusion of the SMA) and reperfusion: 10 min ischemia and 20 min reperfusion (IPC10/20, n = 7), 10 min ischemia and 30 min reperfusion (IPC10/30, n = 8), 15 min ischemia and 20 min reperfusion (IPC15/20, n = 8), and 15 min ischemia and 30 min reperfusion (IPC15/30, n = 9). On the fourth postoperative day, the animals were relaparotomized: bursting pressure, hydroxyproline concentration, and histological ischemia mucosal injury scale of the anastomosis were assessed. RESULTS: Four days after operation, the mean bursting pressure was 73 +/- 6 mmHg in the control group, whereas it was significantly higher in IPC10/20 (113 +/- 11 mmHg; p = 0.018), IPC10/30 (110 +/- 13 mmHg; p = 0.001), and IPC15/30 (124 +/- 9 mmHg; p = 0.003). IPC15/20 did not show a significant difference (63 +/- 2 mmHg; p = 0.4). We did not find a significant effect regarding hydroxyproline concentration, but IPC diminished mucosal injury. CONCLUSIONS: IPC directly before performing a small bowel anastomosis has a time-dependent beneficial effect on anastomotic stability, thus indicating a new clinical approach to improve the healing process of intestinal anastomosis.
BACKGROUND: The aim of our study was to establish whether ischemic preconditioning (IPC) directly before performing a small bowel anastomosis has an effect on anastomotic stability and healing. MATERIAL AND METHODS: Forty male Wistar rats were randomized to five groups: control (CO, n = 8) with preparation of the superior mesenteric artery (SMA) but without IPC. IPC groups had different intervals of ischemia (occlusion of the SMA) and reperfusion: 10 min ischemia and 20 min reperfusion (IPC10/20, n = 7), 10 min ischemia and 30 min reperfusion (IPC10/30, n = 8), 15 min ischemia and 20 min reperfusion (IPC15/20, n = 8), and 15 min ischemia and 30 min reperfusion (IPC15/30, n = 9). On the fourth postoperative day, the animals were relaparotomized: bursting pressure, hydroxyproline concentration, and histological ischemia mucosal injury scale of the anastomosis were assessed. RESULTS: Four days after operation, the mean bursting pressure was 73 +/- 6 mmHg in the control group, whereas it was significantly higher in IPC10/20 (113 +/- 11 mmHg; p = 0.018), IPC10/30 (110 +/- 13 mmHg; p = 0.001), and IPC15/30 (124 +/- 9 mmHg; p = 0.003). IPC15/20 did not show a significant difference (63 +/- 2 mmHg; p = 0.4). We did not find a significant effect regarding hydroxyproline concentration, but IPC diminished mucosal injury. CONCLUSIONS: IPC directly before performing a small bowel anastomosis has a time-dependent beneficial effect on anastomotic stability, thus indicating a new clinical approach to improve the healing process of intestinal anastomosis.
Authors: Andrea Ferencz; Zalán Szántó; Balázs Borsiczky; Katalin Kiss; Károly Kalmár-Nagy; József Szeberényi; Péter Ors Horváth; Erzsébet Róth Journal: Surgery Date: 2002-11 Impact factor: 3.982
Authors: P Sileri; G Sica; P Gentileschi; M Venza; A Manzelli; G Palmieri; L G Spagnoli; G Testa; E Benedetti; A L Gaspari Journal: Transplant Proc Date: 2004-03 Impact factor: 1.066
Authors: Marc A Siemonsma; Ignace H J T de Hingh; Ben M de Man; Roger M L M Lomme; Albert A J Verhofstad; Thÿs Hendriks Journal: Surgery Date: 2003-03 Impact factor: 3.982
Authors: Kristy Hamilton; Erik M Wolfswinkel; William M Weathers; Amy S Xue; Daniel A Hatef; Shayan Izaddoost; Larry H Hollier Journal: Craniomaxillofac Trauma Reconstr Date: 2014-02-21