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The effect of gender on early colonic anastomotic wound healing

International Journal of Colorectal Disease volume 33, pages 1269–1276 (2018)Cite this article

Abstract

Purpose

Clinically, male patients subjected to colorectal surgery are more prone to develop anastomotic leakage than female patients by unknown mechanisms. Our aim was to investigate the impact of gender on anastomotic wound healing using an experimental model.

Methods

One-layer colonic anastomosis was constructed in 8-week-old 28 male and 32 female Sprague-Dawley rats. Animals of one group (n = 30) were sacrificed immediately after surgery day 0 and the other group (n = 30) on postoperative day 3. Anastomotic breaking strength, total collagen (hydroxyproline), soluble collagen (Sircol), matrix metalloproteinase (MMP)-9, and transforming growth factor (TGF)-β1 were measured.

Results

The anastomotic breaking strength decreased from day 0 to day 3 with no significant gender differences either in the extent of decline (P = 0.122) or absolute day 3 strengths (P = 0.425). Analogously, total collagen concentration in the anastomotic wounds decreased postoperatively and were lower (P = 0.043) in the male compared with the female rats on day 3. MMP-9 levels increased in the anastomoses postoperatively, but they did not differ (P = 0.391) between male and female animals. Soluble collagen levels were lower in the day-3 anastomoses of male versus female rats (P = 0.015) and correlated positively with total TGF-β1 levels (rS = 0.540, P = 0.006). Although TGF-β1 tended to be lower in male compared with the female rats, the differences did not reach statistical significance.

Conclusion

Our findings point towards a less favorable collagen metabolism in colonic anastomoses of male compared with female rats during early wound healing.

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Authors and Affiliations

  1. Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    Marie Kjaer, Hrefna Kristjánsdóttir, Magnus S. Ågren & Lars N. Jorgensen

  2. Department of Drug Design and Pharmacology, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark

    Line Andersen & Anne-Marie Heegaard

  3. Copenhagen Wound Healing Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark

    Magnus S. Ågren

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  1. Marie Kjaer
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Correspondence to Marie Kjaer.

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Kjaer, M., Kristjánsdóttir, H., Andersen, L. et al. The effect of gender on early colonic anastomotic wound healing. Int J Colorectal Dis 33, 1269–1276 (2018). https://doi.org/10.1007/s00384-018-3089-4

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Keywords

  • Anastomotic leakage
  • Colorectal surgery
  • Breaking strength
  • Collagen
  • Gender differences
  • Androgens