Preoperative and Postoperative Administration of Hyperbaric Oxygen Improves Biochemical and Mechanical Parameters on Ischemic and Normal Colonic Anastomoses

Abstract

Colonic anastomotic leaks are a major postoperative complication, causing increased mortality and morbidity. Tissue ischemia is one of the most important factors that disrupt anastomotic healing. It is possible to reverse inadequate tissue oxygenation by using increased atmospheric pressure and hyperoxia, which are obtained from hyperbaric oxygen treatment (HBO). Our aim was to investigate the effects of preoperative and postoperative HBO treatment on normal and ischemic colonic anastomoses in rats. Eighty male Wistar Albino rats, weighing between 180 and 240 g, were divided into 8 equal groups. A 1-cm segment of left colon was resected 3 cm proximal to the peritoneal reflection in all groups and colonic anastomosis was performed. In groups 2, 4, 6 and 8, colonic ischemia was established by ligating 2 cm of mesocolon on either side of the anastomosis. Control groups (1 and 2) received no HBO. HBO treatment was given preoperatively in groups 3 and 4, postoperatively in groups 5 and 6, and both preoperatively and postoperatively in groups 7 and 8. HBO treatment was applied for 2 days in the preoperative period and 4 days in the postoperative period. Relaparotomy was performed on postoperative day 5 and a perianastomotic colon segment 2 cm in length was excised for detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation. HBO treatment increased tissue hydroxyproline levels in all groups, and this difference was significant in normal anastomosis groups receiving preoperative HBO compared to controls (p = .013 for group 1 vs. group 3; p = .023 for group 1 vs. group 5). This improvement was more evident in ischemic and normal groups treated by administration of combined pre- and postoperative HBO (p = .021 and p = .013). HBO treatment also increased the mean bursting pressure values in all groups, and again, a statistically significant increase was noted in the ischemic groups compared to controls (p = .002 for group 2 vs. group 6; p = .001 for group 2 vs. group 8). Histopathological evaluation of anastomotic line fibrosis was not found to show significant differences between the groups. Adequate tissue oxygenation is the main factor in wound and anastomosis healing. HBO treatment has a positive effect on biochemical and mechanical parameters of ischemic and normal colon anastomoses in rats. It is possible to see this effect more clearly with combined HBO treatment applied before and after ischemic anastomosis.

Hyperbaric oxygen therapy and mechanical resistence of the colonics anastomosis in rats with peritonitis

“…Yagci et al 18 , used hyperbaric oxygen pre and postsurgically in normal and ischemic colic anastomoses in rats and the concluded that HBO increased the mechanical parameters in ischemic anastomosis, but the increasing in the values of pression of explosion in normal anastomosis was not statistically significant.…”

“…As the surgical techniques and the suture materials, other factors interfere in anastomosis quality, as antibiotics 4,5 , antioxidants 6,7 , antineoplasics 8 , imunossupressors 9 , hormones 10 , trauma 11 , shock [12][13][14] , adherences 15,16 and ischemia 17,18 .…”

Effect of hyperbaric oxygen therapy on esophagojejunal anastomosis healing in rats

“…The literature lists several publications on the negative effects of poorly oxygenated tissue on healing 4,13 . Nevertheless, few studies have assessed the effect of an increased oxygen uptake to digestive tract anastomotic healing [9][10] . The mechanical parameters adopted to assess digestive anastomotic healing are tests that determine the intrinsic resistance of sutures as a surrogate of tissue repair.…”

“…Despite progress in surgical techniques and in the development of suture materials, dehiscence are still observed leading to reoperations, prolonged hospital stays, considerable costs, and higher morbidity and mortality rates 10 . Healing is a multifactoral process, the success of which depends on several local and systemic aspects.…”

“…In the various possible clinical scenarios, one of the methods to increase oxygen levels is hyperbaric oxygen therapy (HBO) 8 . More specifically, a MEDLINE review of the available literature concerning the use of HBO in anastomosis in the alimentary tract retrieved two papers, both addressing colic anastomosis experimentally induced in rats [9][10] . However, no paper on the use of HBO to treat esophageal anastomosis was found.…”