Hyperbaric oxygen therapy improves colorectal anastomotic healing

Boersema, Geesien S. A.; Wu, Zhi‐Yong; Kroese, Leonard F.; Vennix, Sandra; Bastiaansen-Jenniskens, Y.M.; Neck, Johan W. van; Lam, King H.; Kleinrensink, G.J.; Jeekel, J.; Lange, Johan F.

doi:10.1007/s00384-016-2573-y

Cited by 17 publications

(10 citation statements)

References 39 publications

(46 reference statements)

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“…In the present study, the mechanical stability of PLGA–CPO anastomoses was significantly better than that of control anastomoses (Vicryl™ or PLGA) at day 1 and 3. These results support the positive effect of supplemental oxygen administration on the healing and mechanical stability of colonic anastomoses reported by others.…”

Section: Discussionsupporting

confidence: 92%

Effect of oxygen‐producing suture material on hypoxic colonic anastomoses in an experimental model

et al. 2019

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BackgroundAnastomotic leak remains a significant cause of morbidity and mortality after colorectal surgery. Among multiple risk factors considered, hypoxia–ischaemia is considered to be a primary cause of intestinal anastomotic leakage. The aim of this experimental study was to assess safety, usability for surgical tasks, and efficacy of a newly developed oxygen‐producing suture material in the healing of colonic anastomoses under critical conditions.MethodsAn oxygen‐producing suture material was produced that is capable of releasing oxygen directly into the surrounding tissue. Off‐the‐shelf sutures loaded with calcium peroxide nano‐crystals and covered with poly(d,l‐lactide‐co‐glycolide) were assessed in vitro and in a rat model of hypoxic colonic anastomosis.Results In vitro assessment showed that these sutures can increase oxygen levels in a hypoxic environment. Potential oxygen byproducts did not seem to have a negative impact on the viability of intestinal cells. The use of oxygen‐producing sutures in vivo resulted in increased tissue oxygen saturation, measured by visible light spectroscopy, and increased mechanical stability of the anastomosis.ConclusionOxygen‐producing suture material increased tissue oxygen saturation and mechanical stability of colonic anastomosis in a rat model.Surgical relevanceLeakage of anastomoses remains a significant problem after colorectal surgery.An oxygen‐producing suture material was produced that was shown to be safe in vitro and significantly improved several aspects of healing of colonic anastomoses in an animal model.Oxygen‐producing suture material or stapler devices might help to reduce the risk of anastomotic leak of intestinal anastomoses under physiological and critical conditions such as hypoxia.

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Section: Discussionsupporting

confidence: 92%

Effect of oxygen‐producing suture material on hypoxic colonic anastomoses in an experimental model

et al. 2019

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“…More recent examples in rodents with segmental colonic ischaemia at the sites of anastomoses suggested a lack of difference in levels of tissue hypoxia between healed or nonhealed anastomoses . However, in other studies using more severe arterial occlusion, positive effects with hyperbaric oxygen therapy (HBOT) have been demonstrated in healing, and negative effects with systemic hypoxia . In hypoxia, it appears logical that decreasing the partial pressure of available atmospheric oxygen would subsequently decrease the haemoglobin saturation, and thus push oxygen delivery below the threshold for wound healing in a situation of tenuous vasculature.…”

Section: The Role Of Inflammationmentioning

confidence: 99%

The triune of intestinal microbiome, genetics and inflammatory status and its impact on the healing of lower gastrointestinal anastomoses

2017

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Gastrointestinal resections are a common operation and most involve an anastomosis to rejoin the ends of the remaining bowel to restore gastrointestinal (GIT) continuity. While most joins heal uneventfully, in up to 26% of patients healing fails and an anastomotic leak (AL) develops. Despite advances in surgical technology and techniques, the rate of anastomotic leaks has not decreased over the last few decades raising the possibility that perhaps we do not yet fully understand the phenomenon of AL and are thus ill‐equipped to prevent it. As in all complex conditions, it is necessary to isolate each different aspect of disease for interrogation of its specific role, but, as we hope to demonstrate in this article, it is a dangerous oversimplification to consider any single aspect as the full answer to the problem. Instead, consideration of important individual observations in parallel could illuminate the way forward towards a possibly simple solution amidst the complexity. This article details three aspects that we believe intertwine, and therefore should be considered together in wound healing within the GIT during postsurgical recovery: the microbiome, the host genetic make‐up and their relationship to the perioperative inflammatory status. Each of these, alone or in combination, has been linked with various states of health and disease, and in combining these three aspects in the case of postoperative recovery from bowel resection, we may be nearer an answer to preventing anastomotic leaks than might have been thought just a few years ago.

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“…One of the most important factors influencing the anastomotic healing has proven to be the oxygenation on the site of the anastomosis. Correct oxygen levels are needed for leukocytes activation, fibroblasts production and angiogenesis, which are essential for wound healing 8 . The technique of construction of GI anastomoses is also very important.…”

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confidence: 99%

Experimental fortification of intestinal anastomoses with nanofibrous materials in a large animal model

Rosendorf

Horakova

Klíčová

et al. 2020

Sci Rep

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Anastomotic leakage is a severe complication in gastrointestinal surgery. It is often a reason for reoperation together with intestinal passage blockage due to formation of peritoneal adhesions. Different materials as local prevention of these complications have been studied, none of which are nowadays routinely used in clinical practice. Nanofabrics created proved to promote healing with their structure similar to extracellular matrix. We decided to study their impact on anastomotic healing and formation of peritoneal adhesions. We performed an experiment on 24 piglets. We constructed 3 hand sutured end-to-end anastomoses on the small intestine of each pig. We covered the anastomoses with a sheet of polycaprolactone nanomaterial in the first experimental group, with a sheet of copolymer of polylactic acid with polycaprolactone in the second one and no fortifying material was used in the Control group. The animals were sacrificed after 3 weeks of observation. Clinical, biochemical and macroscopic signs of anastomotic leakage or intestinal obstruction were monitored, the quality of the scar tissue was assessed histologically, and a newly developed scoring system was employed to evaluate the presence of adhesions. The material is easy to manipulate with. There was no mortality or major morbidity in our groups. No statistical difference was found inbetween the groups in the matter of level of peritoneal adhesions or the quality of the anastomoses. We created a new adhesion scoring system. The material appears to be safe however needs to be studied further to prove itsʹ positive effects.

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Hyperbaric oxygen therapy improves colorectal anastomotic healing

Cited by 17 publications

References 39 publications

Effect of oxygen‐producing suture material on hypoxic colonic anastomoses in an experimental model

Effect of oxygen‐producing suture material on hypoxic colonic anastomoses in an experimental model

The triune of intestinal microbiome, genetics and inflammatory status and its impact on the healing of lower gastrointestinal anastomoses

Experimental fortification of intestinal anastomoses with nanofibrous materials in a large animal model

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