Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery

Rushfeldt, Christian; Sveinbjørnsson, Baldur; Søreide, Kjetil; Vonen, Barthold

doi:10.1007/s00384-011-1285-6

Cited by 48 publications

(34 citation statements)

References 57 publications

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“…Some authors recommend that the NSAIDs should be abandoned after primary colonic anastomosis because of the increase of leak rate that has been consistently demonstrated in experimental and clinical studies [35][36][37][38][39][40] . This find is due to an effect on collagen metabolism leading to weakened tissue around the anastomosis and on the risk of thrombosis formation leading to a decrease of anastomotic blood flow and ischemic damage.…”

mentioning

confidence: 99%

Ghrelin and gastrointestinal wound healing. A new perspective for colorectal surgery

et al. 2018

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mentioning

confidence: 99%

Ghrelin and gastrointestinal wound healing. A new perspective for colorectal surgery

et al. 2018

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“…Both COX-1 and −2 are believed to be involved in wound healing [10,11] and Figure 1 demonstrates their presence in the healing anastomosis. There is a growing understanding that NSAIDs, and especially those with a certain preference for COX-2, may increase the risk of anastomotic leakage [12,13]. Carprofen is such a drug that is used in domestic animals [14], but is also effective as an analgesic in laboratory animals undergoing laparotomy [15].…”

Section: Discussionmentioning

confidence: 99%

“…The findings reported here may also be relevant to the human situation where NSAIDs are frequently used after gastro-intestinal surgery and are even incorporated in protocols for fast track surgery, despite emerging evidence that they may affect repair [12,13]. …”

Section: Discussionmentioning

confidence: 99%

Carprofen for perioperative analgesia causes early anastomotic leakage in the rat ileum

et al. 2012

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BackgroundThere is increasing evidence that perioperative use of NSAIDs may compromise the integrity of intestinal anastomoses. This study aims to characterize the negative effects of carprofen on early anastomotic healing in the rat ileum.ResultsIn 159 male Wistar rats an anastomosis was constructed in the ileum. In experiment 1 eighty-four rats were divided over control and experimental groups, which received daily buprenorphine or carprofen, respectively, as an analgesic and were killed on day 1, 2 or 3 after surgery. In experiment 2 three groups of 15 rats received carprofen either immediately after surgery or with a delay of 1 or 2 days. Animals were killed after 3 days of carprofen administration. In experiment 3 three groups of 10 rats received different doses (full, half or quarter) of carprofen from surgery.In significant contrast to buprenorphine, which never did so, carprofen induced frequent signs of anastomotic leakage, which were already present at day 1. If first administration was delayed for 48 hours, the leakage rate was significantly reduced (from 80 to 20%; p = 0.0028). Throughout the study, the anastomotic bursting pressure was lowest in animals who displayed signs of anastomotic leakage. Loss of anastomotic integrity did not coincide with reduced levels of hydroxyproline or increased activity of matrix metalloproteinases.ConclusionsCarprofen interferes with wound healing in the rat ileum at a very early stage. Although the mechanisms responsible remain to be fully elucidated, one should be aware of the potential of NSAIDs to interfere with the early phase of wound repair.

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“…Non‐steroidal anti‐inflammatory drugs (NSAIDs) inhibit COX enzymes, leading to a decrease in prostaglandin synthesis. An association between the use of NSAIDs and AL has been described in both experimental and observational studies, suggesting an interaction between prostaglandins and anastomotic healing. PGE 2 could thus have a positive influence on anastomotic healing, mediated by its effect on mucous secretion.…”

Section: Introductionmentioning

confidence: 94%

Functional mucous layer and healing of proximal colonic anastomoses in an experimental model

Bosmans¹,

Jongen²,

Birchenough

et al. 2017

British Journal of Surgery

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A functional mucous layer facilitates the healing of colonic anastomoses. Clinical relevance Colorectal anastomotic leakage remains the most dreaded complication after colorectal surgery. It is known that the aetiology of anastomotic leakage is multifactorial, and a role is suggested for the interaction between intraluminal content and mucosa. In this murine model of proximal colonic anastomotic leakage, the authors investigated the mucous layer at the intestinal mucosa, as the first line of defence, and found that a normal, functioning mucous layer is essential in the healing process of colonic anastomoses. Further research on anastomotic healing should focus on positively influencing the mucous layer to promote better postoperative recovery.

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Risk of anastomotic leakage with use of NSAIDs after gastrointestinal surgery

Cited by 48 publications

References 57 publications

Ghrelin and gastrointestinal wound healing. A new perspective for colorectal surgery

Ghrelin and gastrointestinal wound healing. A new perspective for colorectal surgery

Carprofen for perioperative analgesia causes early anastomotic leakage in the rat ileum

Functional mucous layer and healing of proximal colonic anastomoses in an experimental model

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