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The Effects of Systemic Hypoxia on Colon Anastomotic Healing: An Animal Model

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Diseases of the Colon & Rectum

PURPOSE

Acute postoperative systemic hypoxia occurs frequently in the clinical setting following intestinal resection, as a result of complications such as pneumonia, pulmonary edema, or the acute respiratory distress syndrome. Although it is well established that oxygen is essential for metabolism in general and intestinal anastomotic healing, the mechanisms by which systemic hypoxia affect this process are not clear. The purpose of this study was to establish an animal model to simulate acute systemic hypoxia and to examine the effects on anastomotic healing. We investigated the hypothesis that systemic hypoxia impairs anastomotic healing in the colon by disrupting revascularization via changes in the expression of two putative angiogenic factors: inducible nitric oxide synthase and vascular endothelial growth factor.

METHODS

Phase I: Juvenile male Sprague–Dawley rats underwent carotid artery cannulation. In a controlled environment the FiO2 was incrementally decreased from 21 to 9 percent and the resultant PaO2 measured. Phase II: Animals underwent colonic transection with immediate reanastomosis and were placed in either a normoxic (FiO2 21 percent) or hypoxic (FiO2 11 percent) environment for seven days. Perianastomotic in vivo tissue oxygen saturation was measured before segmental colon resection in each of the animals and at seven days before measurement of anastomotic bursting pressure. Perianastomotic tissue samples were assessed by Western blot assay for the expression of vascular endothelial growth factor and inducible nitric oxide synthase protein. Sections from each tissue sample were taken and evaluated by a pathologist blinded to treatment group for determination of anastomotic healing score.

RESULTS

Phase I: Incrementally decreasing the FiO2 resulted in a progressive decrease in PaO2 (r 2 = 0.77). Phase II: Animals maintained in a hypoxic environment had a significant decrease in tissue oxygen saturation (73 ± 9 percent vs. 94 ± 3 percent; P < 0.0001) and anastomotic bursting pressure (118 ± 18 mmHg vs. 207 ± 30 mmHg; P < 0.0001) compared with normoxic controls. Systemic hypoxia induced a significant increase, when compared with normoxic controls, in vascular endothelial growth factor (247.1 ± 9.5 vs. 142.2 ± 10.6; P < 0.0001) and inducible nitric oxide synthase (259.6 ± 21.1 vs. 120.2 ± 10.9; P < 0.0001) protein expression and led to a significant decrease in the overall wound-healing score.

CONCLUSION

This study validates a new animal model to study the effects of acute systemic hypoxia on colonic anastomotic healing. In this model, systemic hypoxia directly translated into local tissue hypoxia, and anastomotic healing was impaired. Contrary to our original hypothesis, hypoxia led to a significant increase in vascular endothelial growth factor and inducible nitric oxide synthase protein expression at the colonic anastomotic site. Impairment in anastomotic integrity despite upregulation of these angiogenic factors could be a result of the inability of wounded tissue to respond to vascular endothelial growth factor and inducible nitric oxide synthase or alternatively, hypoxia may adversely affect collagen synthesis and deposition directly.

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ACKNOWLEDGMENTS

The authors thank Dr. John Kolb, from the Faculty of Kinesiology, and the Human Performance Research Group for providing the hypoxia generator which allowed this project to occur; the Cardiovascular Research Group, especially Dr. J. V. Tyberg, for the use of their blood gas analyzer; and Gail Wright-Wilson and Laurie Wallace for their assistance.

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Authors and Affiliations

  1. GI Research Group, Department of Surgery, University of Calgary, Calgary, Alberta, Canada

    Jo-Anne P. Attard M.D., FRCSC, Manoj J. Raval M.D., Gary R. Martin B.Sc., W. Donald Buie M.D., M.Sc., FRCSC & David L. Sigalet M.D., Ph.D., FRCSC

  2. Department of Kinesiology, University of Calgary, Calgary, Alberta, Canada

    Jon Kolb Ph.D.

  3. Department of Pathology, University of Calgary, Calgary, Alberta, Canada

    Marjan Afrouzian M.D.

Authors
  1. Jo-Anne P. Attard M.D., FRCSC
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  2. Manoj J. Raval M.D.
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  4. Jon Kolb Ph.D.
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  6. W. Donald Buie M.D., M.Sc., FRCSC
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  7. David L. Sigalet M.D., Ph.D., FRCSC
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Correspondence to Jo-Anne P. Attard M.D., FRCSC.

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Supported by Alberta Children’s Hospital Research Foundation.

Reprint requests to: David L. Sigalet, M.D., Ph.D., FRCSC, Department of Surgery, Room 1746, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 2T9.

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Attard, JA., Raval, M., Martin, G. et al. The Effects of Systemic Hypoxia on Colon Anastomotic Healing: An Animal Model. Dis Colon Rectum 48, 1460–1470 (2005). https://doi.org/10.1007/s10350-005-0047-3

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