Is combined therapy more effective than growth hormone or hyperbaric oxygen alone in the healing of left ischemic and non-ischemic colonic anastomoses?

Abstract

OBJECTIVE:Our aim was to investigate the effects of growth hormone (GH), hyperbaric oxygen and combined therapy on normal and ischemic colonic anastomoses in rats.METHODS:Eighty male Wistar rats were divided into eight groups (n = 10). In the first four groups, non-ischemic colonic anastomosis was performed, whereas in the remaining four groups, ischemic colonic anastomosis was performed. In groups 5, 6, 7, and 8, colonic ischemia was established by ligating 2 cm of the mesocolon on either side of the anastomosis. The control groups (1 and 5) received no treatment. Hyperbaric oxygen therapy was initiated immediately after surgery and continued for 4 days in groups 3 and 4. Groups 2 and 6 received recombinant human growth hormone, whereas groups 4 and 8 received GH and hyperbaric oxygen treatment. Relaparotomy was performed on postoperative day 4, and a perianastomotic colon segment 2 cm in length was excised for the detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation.RESULTS:Combined treatment with hyperbaric oxygen and GH increased the mean bursting pressure values in all of the groups, and a statistically significant increase was noted in the ischemic groups compared to the controls (p<0.05). This improvement was more evident in the ischemic and normal groups treated with combined therapy. In addition, a histopathological evaluation of anastomotic neovascularization and collagen deposition showed significant differences among the groups.CONCLUSIONS:Combined treatment with recombinant human growth hormone and hyperbaric oxygen resulted in a favorable therapeutic effect on the healing of ischemic colonic anastomoses.

Effect of preconditioning and postoperative hyperbaric oxygen therapy on colonic anastomosis healing with and without ischemia in rats

“…Other two studies corroborate our findings of no significant differences in ischemic necrosis and reepithelization 8,16 .…”

“…Previous studies had different results with statistically significant increase in HBOT groups in neovascularization 16,27,30 , and in collagen deposition 8 .…”

“…With an alpha = 0.05 and power = 0.85, able to detect a 20% statistical significant difference calculated by T-Test for two samples, the sample size estimated with this effect size was approximately N = 10 for each group. This size group was used in similar studies 4,7,16 .…”

“…A colon segment 2 cm cranial to the landmark was isolated and the venous-arterial branches that drained or irrigated this left colonic segment were electrocoagulated. The mesenteric vessels of the vasa recta were electrocoagulated with bipolar hemostatic forceps set to 10 W. Then, 1 cm of the middle third of this devascularized portion was resected, as described by Adas et al 16 . The colon was then repaired by a single-plane end-toend anastomosis with continuous 6-0 polypropylene sutures placed with a 1.3 cm cylindrical needle (Prolene ® , ETHICON), encompassing all layers of the intestinal wall.…”

Deneysel Künt Duodenum Yaralanmalarında Hiperbarik Oksijen Tedavisi ve Timokinon’un Etkisi

“…Bu tedavi, sadece iskeminin yan etkilerini önlemekle kalmaz, aynı zamanda farklı yara tiplerinin iyileşmesinde de etkili olur. Yapılan deneysel çalışmalarda, kolonik anastomozlarda gelişebilecek kaçak oranını azalttığı gösterilmiştir (9)(10)(11).…”