Smoking, hypertension, and colonic anastomotic healing; a combined clinical and histopathological study.

Fawcett, A. W.; Shembekar, M; Church, J S; Vashisht, Rajiv; Springall, R G; Nott, D. M.

doi:10.1136/gut.38.5.714

Cited by 106 publications

(79 citation statements)

References 15 publications

(1 reference statement)

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“…pages 1053-1058 . ..................................................................................................................................................................................................................... surgery in smokers compared with non-smokers [20]. Smokers undergoing ambulatory surgery have a 2-fold increased risk of respiratory complications, and a 16-fold increased risk of wound infection [9].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of bupropion as an aid to stopping smoking before elective surgery: a randomised controlled trial

et al. 2004

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SummarySmoking is a risk factor for complications during and after surgery, but most smokers are unable to quit before elective surgery. We tested the efficacy of bupropion in improving smoking cessation rates in this setting by enrolling 47 patients from the elective surgery waiting list in a double-blind randomised controlled trial. Patients receiving bupropion had a lower daily cigarette consumption at the time of hospital admission, median (IQR) cigarettes per day: 6 (2-7) vs. 15 (9-20), p = 0.046. They also had a reduction in end-expired carbon monoxide (p = 0.004), a known contaminant of cigarette smoke, and increased arterial oxygen saturation on pulse oximetry (p = 0.011). They were more likely to have stopped smoking at the 3-week visit (p = 0.036), but not at the 6-week visit (p = 0.25) or at the time of hospital admission for surgery (p > 0.99). This study found that smokers waiting for elective surgery are more likely to reduce or stop smoking when treated with bupropion.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of bupropion as an aid to stopping smoking before elective surgery: a randomised controlled trial

et al. 2004

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“…The mechanism through which smoking affects AL is still unclear; however, involvement of a decrease in mucosal blood flow has been reported [21][22][23] . In the present study, the four patients who experienced AL were current smokers and had heavy smoking histories.…”

Section: Discussionmentioning

confidence: 99%

Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment

Matsuzaki

Ishihara

Kawai

et al. 2017

J Anus Rectum Colon

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Abstract:Objectives: To clarify the surgical outcomes and risk factors for anastomotic leakage (AL) following laparoscopic anterior resection (Lap-AR) for the treatment of rectal cancer. Methods: We retrospectively reviewed the records of 175 consecutive primary rectal cancer patients who had undergone Lap-AR at our institution between April 2012 and November 2015. Patient, tumor, and surgical variables were analyzed using univariate analyses. Results: Of 175 patients, 116 were men (66.3%). All four patients who had AL (2.3%) were men and current smokers with heavy smoking histories. In three of the AL cases, preoperative total colonoscopy was impossible owing to tumor obstruction, and the other case had concomitant obstructive colitis after oral bowel preparation. Univariate analysis identified tumor size, tumor obstruction, and smoking history as factors significantly associated with AL development. Conclusions: Tumor size, tumor obstruction, and smoking history were risk factors for AL following Lap-AR for the treatment of primary rectal cancer.

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“…Moreover, there might be different pathophysiological mechanisms evaluated in this model where larger vessels are coagulated, compared with high risk patients who suffer from microvascular disease. [1][2][3] Another reason could be a technical issue since the vessels in this model were divided with bipolar coagulation. However, the mesentery of bowel was not transected with scissors after the coagulation was done.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with such conditions have been shown to have microvascular disease in the anastomotic tissue, which may impair perfusion, creating ischemia and anastomotic leakage. [1][2][3] Existing animal models inducing isolated colon anastomotic ischemia have failed to create clinical leakage with abscess or fecal peritonitis. 4,5 Using a combination of ischemia and technical insufficiency, other models have been able to create clinical leakage, but the effect of ischemia on the colonic anastomosis alone remains unknown.…”

mentioning

confidence: 99%

Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

Pommergaard

Achiam

Burcharth

et al. 2015

International Surgery

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Colon anastomotic leakage has a multifactorial etiology and ischemia is considered one of the most important single factors. However, no existing animal models have established a direct link between ischemia and anastomotic leakage. The aim of this study was to establish a model of colon anastomotic leakage as a result of tissue ischemia. In colon anastomoses of 53 C57BL/6 mice, varying degrees of ischemia were induced. Supplying vessels were divided with bipolar coagulation in order to reduce anastomotic breaking strength and create clinical anastomotic leakage. Breaking strength of all the ischemic anastomoses were significantly lower compared with controls. Increasing ischemia resulted in higher rates of large bowel obstruction without creating anastomotic leakage. Healing was compromised as a result of impaired blood supply. However, clinical leakage was absent. Pure ischemia in otherwise healthy experimental animals may be too simple of an approach to create clinical leakage.

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Smoking, hypertension, and colonic anastomotic healing; a combined clinical and histopathological study.

Abstract: Background-Large bowel anastomotic breakdown occurs as a result of perianastomotic ischaemia. Preservation of the macroscopic arterial supply to the perianastomotic tissues is vital, but little is known about the influence of microvascular disease on anastomotic healing.

Cited by 106 publications

References 15 publications

Effectiveness of bupropion as an aid to stopping smoking before elective surgery: a randomised controlled trial

Effectiveness of bupropion as an aid to stopping smoking before elective surgery: a randomised controlled trial

Smoking and tumor obstruction are risk factors for anastomotic leakage after laparoscopic anterior resection during rectal cancer treatment

Impaired Blood Supply in the Colonic Anastomosis in Mice Compromises Healing

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