Anastomotic integrity after operations for large-bowel cancer: a multicentre study.

Fielding, L P; Stewart‐Brown, Sarah; Blesovsky, L; Kearney, Gary P.

doi:10.1136/bmj.281.6237.411

Cited by 436 publications

(159 citation statements)

References 15 publications

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“…This phenomenon is still seen rather frequently, even in cases of elective surgery under optimal conditions (Fielding et al, 1980). Since antineoplastic agents interfere with wound healing (Ferguson, 1982), the Collagen synthesis in ileal anastomotic tissue was measured after incorporation of 3H-proline.…”

Section: Discussionmentioning

confidence: 99%

Intraperitoneal cytostatics impair early post-operative collagen synthesis in experimental intestinal anastomosesP6

Martens¹,

Hendriks²,

Wobbes³

et al. 1992

Br J Cancer

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Summary Collagen synthesis in intestinal anastomoses has been measured in rats after in vivo administration of cytostatics. The cytostatics were administered during 5 consecutive days either intravenously or intraperitoneally. On day 3 of the course the rats received both an ileal and a colonic anastomosis. The animals were sacrified 3 and 7 days after operation. The cytostatics regimen used was a combination of 5-fluorouracil, bleomycin and cisplatinum in a dose of 10, 2 and 0.35 mg kg-' day-', respectively. In an additional group, a twice higher dose was given intraperitoneally.Three days after operation a severe inhibition of the collagen synthesis was observed in all the cytostatics treated groups, both in ileum and in colon. The effects of intraperitoneal administration were much more pronounced than those observed after an equal dose given intravenously. Seven days after operation the collagen synthesis in the intravenously treated groups was restored to the level of the control group. However, in the intraperitoneal groups the collagen synthesis in ileal anastomoses was still inhibited.Thus, cytostatics suppress collagen synthesis in intestinal anastomoses. The effect is more severe after intraperitoneal than after intravenous administration, confirming our earlier hypothesis that the former mode of administration comprises a higher risk for anastomotic integrity.

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Section: Discussionmentioning

confidence: 99%

Intraperitoneal cytostatics impair early post-operative collagen synthesis in experimental intestinal anastomosesP6

Martens¹,

Hendriks²,

Wobbes³

et al. 1992

Br J Cancer

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“…Although the good development of intestinal suture in recent years, the large intestine maintain the highest rates of complications (such as fistulas), when compared with small intestine or stomach 3,10 .…”

Section: Discussionmentioning

confidence: 99%

“…Among the factors reported as associated with large intestine anastomotic dehiscence and septic complications are: bad preparation of the colon for surgery, bad patient's nutritional status, associated diseases, suture in diseased intestine, intestinal ischemia, tension on the suture line, inadequate points of suture, trauma, perforation, use of drains and construction with anastomosis below the peritoneal reflection 1,3,9,10 .…”

Section: Introductionmentioning

confidence: 99%

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Cecorraphy in single layer using polypropylene and poliglecaprone 25 threads: comparative study in rats

Tabushi¹,

Nomura²,

Malafaia

et al. 2012

Acta Cir. Bras.

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PURPOSE:To compare sutures with polypropylene and poliglecaprone 25 after partial cecotomy in rats. METHODS:Thirty six rats divided into two groups, A and B, of 18 animals; each group was also divided into three subgroups of six animals sacrificed at 4 th , 7 th and 14 th days after surgery. Were studied the mortality, morbidity, complications attributable to sutures, macroscopy, optical microscopy and measurement of hydroxyproline at the level of the suture. RESULTS:There were no deaths or wound complications such as hematoma, seroma, abscess, evisceration or eventration. On microscopic evaluation reepithelization, coaptation and inflammation in both groups did not differ significantly. The average rate of tissue hydroxyproline found in the samples on the 4 th day after surgery, was 21.38 mg/g tissue for group A and 16.68 mg/g for group B; on day 7 after surgery, the average was 15.64 mg/g tissue for group A and 26.53 mg/g for group B; on day 14, the average was 8.09 mg/g tissue for group A and 25.07 mg/g for group B.CONCLUSION: There were no differences on clinical evolution, macroscopic aspect, microscopic data and hydroxyproline concentration on both sutures.Key words: Suture Techniques. Anastomosis, Surgical. Cecum. Polypropylenes. Rats. RESUMO OBJETIVO:Comparar a sutura com fio de polipropileno e poliglecaprone 25 após cecotomia parcial em ratos. MÉTODOS:Trinta e seis ratos foram distribuídos em dois grupos A e B de 18 animais, e cada grupo foi dividido em três subgrupos de seis, sacrificados no 4º, 7º e 14º dias do pós-operatório. Estudou-se a mortalidade, morbidade, complicações atribuíveis às suturas, macroscopia, microscopia ótica e dosagem de hidroxiprolina no nível da sutura. RESULTADOS:Não houve mortalidade ou complicações da ferida operatória como hematoma, seroma, abscesso, evisceração ou eventração.Na avaliação microscópica os critérios de re-epitelização, coaptação e processo inflamatório ambos os grupos não apresentaram diferença significativa. A taxa tecidual média da hidroxiprolina encontrada nas amostras no 4º dia de pós-operatório foi de 21,38 mg/g de tecido para o grupo A e 16,68 mg/g para o grupo B; no 7º dia a média foi de 15,64 mg/g de tecido para o grupo A e 26,53 mg/g para o grupo B; no 14º dia ela foi de 8,09 mg/g de tecido para o grupo A e 25,07 mg/g para o grupo B.CONCLUSÃO: Não houve diferença estatística entre a evolução clínica, avaliação macroscópica, microscopia e dosagem de hidroxiprolina entre as suturas realizadas com os fios estudados.Descritores: Técnicas de Sutura. Anastomose Cirúrgica. Ceco. Polipropilenos. Ratos.Tabushi FI et al.

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“…Many factors contribute to wound healing and the integrity of an anastomosis, such as blood supply, tension of the anastomosis, bowel preparation, patient condition and inflammation (8). In addition, peptide growth factors (PGFs) play a significant role in wound healing.…”

Section: Introductionmentioning

confidence: 99%

Safety and effectiveness of mechanical versus hand suturing of intestinal anastomoses in an animal model of peritonitis

Tajima

Kono

Ninomiya

et al. 2012

Experimental and Therapeutic Medicine

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Abstract. Mechanical stapling for colorectal anastomosis is popular, but the safety of its use for anastomosis in peritonitis is unclear. We evaluated the safety and effectiveness of mechanically stapled vs. hand-sutured anastomosis by comparing wound healing in an animal model of bacterial peritonitis. Male Sprague-Dawley (n=48) rats underwent cecal ligation and puncture. After 24 h, rats were divided into two groups: the stapler group (cecal resection with mechanical stapler, n=24) and the hand-sutured group (cecal resection and stump closure with surgical absorbable suture, n=24). Anastomotic segments were excised and as indicators of wound healing, anastomotic bursting pressure (ABP) and tissue hydroxyproline concentration were determined over time. After harvesting, anastomotic segments were analyzed by quantitative real-time polymerase chain reaction (PCR) to determine relative expression of transforming growth factor-β 1 (TGF-β 1 ) and vascular endothelial growth factor (VEGF) normalized to that of a constitutive gene. The operative time was significantly shorter in the stapler vs. the hand-sutured group. Both groups showed progressive increases in ABP over the postoperative period. ABP was significantly higher in the stapler vs. the hand-sutured group on postoperative days (PODs) 0 and 3. Tissue hydroxyproline concentration increased from POD 7 in both groups, but between-group difference was not significant. Both groups showed progressive increases in TGF-β 1 and VEGF expression during the 7-day postoperative period. On POD 5, TGF-β 1 gene expression was higher in the stapler vs. the hand-sutured group. VEGF gene expression was identical in both groups. In conclusion, anastomosis by stapler is safer and more effective than that by hand suturing in bacterial peritonitis, since it requires less operating time and creates stronger anastomoses in the early postoperative period. IntroductionAnastomotic dehiscence following gastrointestinal surgery, particularly colorectal surgery, is a significant cause of morbidity and mortality, and leakage from colonic anastomosis is a major concern for surgeons. The incidence of reported anastomotic leakage varies between 10 and 13% (1,2). Presently, the use of mechanical staplers for colorectal anastomoses has been increasing and is becoming widely accepted in Western countries due to the short procedure time and reliability afforded by this technique. It has reduced the operation time, has facilitated the performance of gastrointestinal anastomoses at sites with a poor field of view and has decreased the likelihood of suture failure (3,4). Several prospective randomized controlled studies have compared hand suturing with mechanical stapling in patients undergoing total gastrectomy and low anterior colorectal resection (5-7). However, hand-sutured anastomoses are still popular due to economic conditions in developing countries, and few experimental studies have yet been reported comparing wound healing of stapled anastomosis with hand-sutured anastomosis, particularly i...

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Anastomotic integrity after operations for large-bowel cancer: a multicentre study.

Cited by 436 publications

References 15 publications

Intraperitoneal cytostatics impair early post-operative collagen synthesis in experimental intestinal anastomosesP6

Intraperitoneal cytostatics impair early post-operative collagen synthesis in experimental intestinal anastomosesP6

Cecorraphy in single layer using polypropylene and poliglecaprone 25 threads: comparative study in rats

Safety and effectiveness of mechanical versus hand suturing of intestinal anastomoses in an animal model of peritonitis

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