Effect of the Combination of Fibrin Glue and Growth Hormone on Intestinal Anastomoses in a Pig Model of Traumatic Shock Associated with Peritonitis |
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Authors: | Pengfei Wang Jian Wang Wenbo Zhang Yousheng Li Jieshou Li |
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Institution: | (1) Medical College, Nanjing University, Nanjing, Jiangsu Province, 210002, People’s Republic of China;(2) Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing, Jiangsu Province, 210002, People’s Republic of China |
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Abstract: | Background Intra-abdominal sepsis and hemorrhagic shock have been found to impair the healing of intestinal anastomoses. The present
study examined whether fibrin glue (FG) and recombinant human growth hormone (GH) can improve intestinal primary anastomotic
healing in a pig model of traumatic shock associated with peritonitis. Further, the study was designed to investigate the
probable mechanism of these agents.
Methods Female anesthetized pigs were divided into five groups. Group sham (n = 7), pigs without traumatic shock had small bowel resection anastomoses; group control (n = 14), pigs had bowel resection anastomoses 24 h after abdominal gunshot plus exsanguination/resuscitation; group FG (n = 14); group GH (n = 14); group FG/GH (n = 14), pigs received FG, recombinant GH, or both, respectively. Recombinant GH was given daily for 7 days. Blood samples
were collected daily for measurement of interleukin-6 (IL-6) and tumor necrosis factor (TNF)-α levels. Investigations also
included adhesion formation, anastomotic bursting pressure, tensile strength, hydroxyproline (HP) content, myeloperoxidase
(MPO), tumor necrosis factor (NF)-κB activity, and histology analysis 10 days later. A second experiment (n = 20 subjects assigned to each of the five groups) was designed to study survival during the first 20 postoperative days.
Results Traumatic shock associated with peritonitis led to significant decreases in intestinal anastomotic bursting pressures, tensile
strengths, and tissue hydroxyproline content, along with severe adhesion formation, increases in MPO activity and NF-κB activity,
and plasma levels of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). Both FG and recombinant GH treatment led
to early significant increases in plasma levels of TNF-α and IL-6. At the same time, FG alone, unlike recombinant GH alone,
led to significant increases in anastomotic bursting pressures, tensile strength, and tissue HP content, along with decreases
in anastomotic MPO and NF-κB activity and later plasma levels of TNF-a and IL-6. The FG group also developed more marked neoangiogenesis
and collagen deposition on histology analysis. However, FG and recombinant GH synergistically effected improved anastomotic
healing, abolishing the infaust effects promoted by recombinant GH. Adhesion formation after intestinal anastomosis could
not be lowered by FG alone or by the combination of FG and recombinant GH. Both FG alone and FG/GH, in contrast to GH alone
and control treatment, significantly prolonged the survival time of experimental animals.
Conclusions We found that FG, but not recombinant GH, could lower the risk of anastomotic leakage, improve intestinal anastomotic healing,
and prolong survival in a pig model of traumatic shock associated with peritonitis. Both FG and recombinant GH synergistically
effected improved intestinal anastomotic healing. It was suggested that GH could be used locally to promote intestinal anastomotic
healing in intra–abdominal peritonitis. |
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