Effects of the Oral Nutritional Supplement Containing Arginine, Glutamine, and Hydroxymethylbutyrate (Abound®) on Healing of Colonic Anastomoses in Rats

Abstract

We evaluated the effects of the oral nutritional supplement containing arginine, glutamine, and hydroxymethylbutyrate (Abound®) on healing of colonic anastomoses in experimental rat model. Seventy WistarAlbino male rats were divided into seven groups. Colon transection and anastomosis were performed in all groups except for the sham group. In groups 2 and 5, rats were fed with standard rat chow after the operation. Oral nutritional supplement was added to standard nutrition for 3 days postoperatively in group 3 and 7 days in group 6 and preoperative 7 days plus postoperative 3 days in group 4 and preoperative 7 days plus postoperative 7 days in group 7. Bursting pressures were measured, adhesions were evaluated, and tissue samples were taken for measurement of tissue hydroxyproline levels and for histopathological examination. The usage of oral nutritional supplement had positive effects on bursting pressures, tissue hydroxyproline levels, and histopathological findings of anastomoses, but feeding with oral nutritional supplement both preoperatively and postoperatively had no additive effect on these parameters when compared with the groups that were fed only postoperatively. The mixture of arginine, glutamine, and hydroxymethylbutyrate may be safely used for achieving better healing results after colonic anastomoses.

Enhancing intestinal anastomotic healing using butyrate: Systematic review and meta-analysis of experimental animal studies

“…Eleven studies assessed their outcomes on only one time point, of which two [ 10 , 16 ] within the first 4 days after surgery (a), and nine [ 4 , 5 , 13 , 19 , 22 , 26 , 29 , 32 , 37 ] on day 5 or later (b). Eight studies [ 7 , 27 , 28 , 30 , 32 , 33 , 38 , 39 ] performed outcome assessments in both time frames (a, b).…”

“…This relative increase in mature collagen in the anastomosis was still present at 14 days after index surgery. Other studies that found an effect of butyrate administration on collagen deposition in anastomoses were the studies from Yaman (2012) [ 40 ] and Kusabbi (2015) [ 33 ]. In both studies an increase in collagen deposition in the anastomotic area was observed after a daily (before and/or after surgery) administration of AGHMB, a butyrate based oral nutritional supplement.…”

“…Terzi [ 38 ], in their additional experiment regarding anastomotic healing and radiotherapy (IAH), concluded the same on the effect of SCFAs on necrosis and granulation tissue in irradiated anastomoses. The third study [ 33 ] that found an increase in inflammatory cell infiltration, also showed an increase in neovascularization and fibroblast proliferation in almost all experimental groups. This study, by Kusabbi and colleagues (2015) [ 33 ], investigated the effect of an oral nutritional supplement containing AGHMB on anastomotic healing in rats.…”

“…The third study [ 33 ] that found an increase in inflammatory cell infiltration, also showed an increase in neovascularization and fibroblast proliferation in almost all experimental groups. This study, by Kusabbi and colleagues (2015) [ 33 ], investigated the effect of an oral nutritional supplement containing AGHMB on anastomotic healing in rats. Other groups that investigated the effect of AGHMB on anastomotic healing found a similar effect on neovascularization and fibroblast proliferation 7 days postoperative (Akbulut et al, 2019) [ 29 ], and saw an increase in reepithelialisation (Yaman et al, 2012) [ 40 ].…”

“…In the narrative analysis on histological effects of butyrate administration on anastomotic healing, no apparent effect of butyrate on general wound healing parameters was found. Nevertheless, some studies [ 28 , 29 , 32 , 33 , 38 , 40 ] demonstrated positive effects on inflammatory cell infiltration, reepithelialisation, fibroblast proliferation and neovascularisation, of which some have also been mentioned in the latest review of Hajjar and colleagues (2021) [ 18 ] concerning the role of butyrate in colorectal cancer surgery. The lack of a clear and consistent conclusion in this review might have been caused by the limited amount of studies included and the substantial heterogeneity between the studies.…”