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Ischemic preconditioning improves stability of intestinal anastomoses in rats

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

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.

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Authors and Affiliations

  1. Department of General and Digestive Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg im Breisgau, Germany

    Goran Marjanovic, Ulrich Theodor Hopt & Robert Obermaier

  2. Institute of Pathology, University of Freiburg, Freiburg im Breisgau, Germany

    Eva Jüttner & Axel zur Hausen

Authors
  1. Goran Marjanovic
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  2. Eva Jüttner
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  3. Axel zur Hausen
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  4. Ulrich Theodor Hopt
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  5. Robert Obermaier
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Correspondence to Goran Marjanovic.

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Marjanovic, G., Jüttner, E., zur Hausen, A. et al. Ischemic preconditioning improves stability of intestinal anastomoses in rats. Int J Colorectal Dis 24, 975–981 (2009). https://doi.org/10.1007/s00384-009-0696-0

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