Protection of intestinal anastomosis with biological glues: an experimental randomized controlled trial

Background  

The aim of the study was to compare the degree of healing and air tightness of hand-sewn colonic anastomoses provided by different biological glues.     

The integrity of colonic anastomoses following the intraperitoneal administration of oxaliplatin

Introduction  

The purpose of this experimental study was to determine the effect of oxaliplatin on the integrity of colonic anastomoses which were under oxaliplatin administration.     

Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing

Purpose  

This study investigated whether covering the colonic anastomoses with amniotic membrane (AM) protects the anastomotic healing from the adverse effects of immediate 5-fluorouracil (5-FU) administration.     

The Effects of Intraperitoneal Sildenafil Administration on Healing of Left Colonic Anastomoses and Intra-Abdominal Adhesion Formation in the Presence of Intra-Abdominal Infection

Purpose

The objective of this pilot study was to establish an animal model for intra-abdominal infection and to examine the effect of sildenafil on anastomotic healing of the left colon and intra-abdominal adhesion formation.

Methods

Fourteen Winstar rats underwent colonic transsection and primary anastomosis after performing intra-abdominal infection. Rats were divided into two groups: Group 1 (n?=?7): intra-abdominal infection, resection, and anastomoses; Group 2 (n?=?7): intra-abdominal infection, resection, anastomoses, and sildenafil. Anastomotic bursting pressures, hydroxyproline levels, histopathologic grading, and abdominal adhesions were accessed on the postoperative Day 7.

Results

Anastomotic healing was found to be improved in terms of a bursting pressure (P?=?0.02). Histopathological examination revealed an increase in angiogenesis (P?=?0.007). Moreover, intra-abdominal adhesions were significantly less in rats given sildenafil (P?=?0.03).

Conclusion

Sildenafil may improve anastomotic healing of the left colon and diminishes peritoneal adhesion formation in the presense of abdominal infection.     

Enhancement of colonic anastomotic strength in rats by short-chain fatty acids

Background

The present study is aiming at elucidating the effect of intraoperative lavage with short-chain fatty acids (SCFAs) on colonic anastomosis in rats.

Methods

Forty male Wistar rats were randomized into four groups (10 rats each). After resection of a segment of transverse colon, an end-to-end anastomosis was performed. In the 1st group, no intraoperative large bowel lavage was performed; in the 2nd, a lavage with normal saline solution; in the 3rd, the animals received a diet rich in SCFAs pre- and postoperatively, and a lavage with normal saline was performed; and in the 4th group, an intraoperative lavage with SCFAs was carried out. On the 4th postoperative day, the animals were sacrificed. Septic complications, adhesions and anastomoses were graded macroscopically and histologically, and bursting pressure of the anastomoses, CRP, IL-6 and TNF-a was measured.

Results

Fewer septic complications (abscesses and minimal ruptures) and adhesions were observed in the 4th group with the intraoperative lavage with SCFAs. The bursting pressure also, in the same group, was higher (73.3 mmHg), followed by the 1st group (67.1 mmHg).

Conclusion

Intraoperative lavage with SCFAs increases the bursting pressure of colonic anastomoses, while lavage with saline solution decreases it, in comparison to the group without lavage.

     

The use of fibrin glue in the treatment of complex perianal fistulae: a case report

Background  

Loop ileostomy is widely employed as a defunctioning procedure for left-sided colonic anastomoses. Closure of the stoma carries a risk of morbidity and even mortality. The aim of this prospective trial was to evaluate the ability of stapled stoma closure to decrease the rates of perioperative morbidity.     

Comparison of a colonic J-pouch and transverse coloplasty pouch in patients with rectal cancer after an ultralow anterior resection using fecoflowmetric profiles

Purpose  

Because the standard straight coloanal anastomosis for low rectal cancer tends to result in unfavorable outcomes in terms of defecatory function, colonic pouch reconstruction has therefore recently been adopted in many institutions. The colonic J-pouch (CJP)- and transverse coloplasty pouch (TCP)-anal anastomoses have been adopted worldwide. However, the comparative benefits and drawbacks of the two procedures are uncertain. This study was designed to analyze the functional and clinical outcomes after an ultralow anterior resection (ULAR) using the fecoflowmetry (FFM).     

Impact of tissue adhesives on the prevention of anastomotic leakage of colonic anastomoses: an in vivo study

Background

Tissue adhesives (TA) may be useful to strengthen colorectal anastomoses, thereby preventing anastomotic leakage (AL). Previous studies have identified cyanoacrylate (CA) TAs as the most promising colonic anastomotic sealants. This study investigates the protective effects of sealing colonic anastomoses with various CAs.

Materials and methods

Fifty-five Wistar rats underwent laparotomy and transection of the proximal colon. An anastomosis was created with 4 interrupted sutures followed by either application of Histoacryl Flexible, Omnex, Glubran 2, or no TA seal. An additional control group was included with a 12-suture anastomosis and no TA seal. After 7 days, the rats were sacrificed and scored for the presence of AL as the main outcome. Secondary outcomes were the occurrence of bowel obstruction, adhesions, and anastomotic bursting pressure. Histological evaluation was performed.

Results

The highest AL rate was found in the Glubran 2 group (7/11), followed by the 4-sutures group without TA (5/11), and the Omnex group (5/11). Histoacryl Flexible showed the lowest AL rate (2/11). In the control group, only one rat showed signs of AL. Histologically, the highest influx of inflammatory cells was found in the 4-suture group without TA and for Omnex and Glubran 2. Histoacryl Flexible caused more mature collagen deposition when compared to the other TA groups.

Conclusions

Histoacryl Flexible showed the lowest leakage rate compared to the other TA groups and to the 4-suture control group. Glubran 2 showed the highest AL rate and a high inflammatory response. Histoacryl Flexible was associated with the presence of more mature collagen and seems to promote anastomotic healing.

     

Small intestinal submucosa for reinforcement of colonic anastomosis

Background  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. Materials and methods  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. Results  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. Conclusion  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.     

The Effect of Azathioprine on Anastomotic Healing: An Experimental Study in Rats

Purpose

The cytotoxic and immunosuppressive effects of azathioprine, which mitigate the disease activity in inflammatory bowel disease, may compromise the healing of intestinal anastomoses leading to an increased risk of anastomotic leakage. The effect of azathioprine treatment on intestinal healing was tested.

Methods

In an experimental study, rats were randomly given one oral dose of azathioprine (5 mg or 20 mg/kg body weight per day) or placebo. After 28 days of treatment, a left colonic anastomosis was performed. After three days of healing, the breaking strengths of the anastomoses were tested, along with measurements of azathioprine major metabolite concentrations: 6-thioguanine and 6-methyl-mercaptopurine.

Results

There were no significant differences in the anastomotic breaking strength between the three groups.

Conclusions

Daily treatment for four weeks with high or low azathioprine doses has no inhibitory effect on colonic healing in rats.

     

Shortcomings in colonic stenting to palliate large bowel obstruction from extracolonic malignancies

Aim  

The aim of this study is to report our experience gained after attempted colonic stenting for colonic obstruction from extracolonic cancer.     

Compression anastomoses in colon and rectal surgery with the NiTi ColonRing?

Background  

The aim of this prospective study was to evaluate safety and efficacy of the NiTi ColonRing™ for anastomoses on the colon or rectum.     

Risk factors for morbidity and mortality after single-layer continuous suture for ileocolonic anastomosis

Aim  

The study was designed to determine the suitability of a single-layer continuous anastomosis for ileo-colonic anastomoses and to determine perioperative risk factors for morbidity and mortality in a teaching hospital.     

Does the outcome of colonic flexure cancers differ from the other colonic sites?

Background  

Anecdotally, colonic flexure cancers (FC) appear to have a poorer prognosis compared to other colonic cancers (OCC). The aim of this study was to determine the outcome of colonic flexure cancers compared to the cancers of the rest of the colon.     

In PSC with Colitis Treated with UDCA,Most Colonic Carcinomas Develop in the First Years After the Start of Treatment

Background  

Patients with PSC and IBD have a high incidence of colonic carcinomas (CRC), and the annual incidence of CRC increases with duration of disease. UDCA treatment has been suggested to reduce colonic dysplasias and carcinomas.     

A Comparison of Palliative Stenting or Emergent Surgery for Obstructing Incurable Colon Cancer

Background  

Acute colonic obstruction because of advanced colonic malignancy is a surgical emergency. Our aim was to review our experience with self-expanding metal stents (SEMS) compared to emergent surgery as the initial therapy for the management of patients with incurable obstructing colon cancer.     

Colonic ischemia following surgery for sigmoid colon and rectal cancer: a study of 10 cases and a review of the literature

Purpose  

Colonic ischemia following colorectal surgery is an unusual and serious complication. As it has been reported that the incidence of colonic ischemia was higher after laparoscopic surgery, the aim of this report was to document the clinical features of postoperative colonic ischemia following colorectal surgery.     

The effects of tacrolimus on colonic anastomotic healing in rats

Aim  

The aim of this experimental study is to investigate the effects of tacrolimus on colonic anastomotic healing after subcutaneous administration.     

Prevalence of Colorectal Polyps in Pediatric Colonoscopy

Background  

The available data regarding the prevalence, types, and clinical determinants of colonic polyps in children is limited.