The Effect of a Special Amino Acid Mixture on Healing of Left Colonic Anastomosis: an Experimental Study

Abstract

A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Arginine, glutamine, and Beta-hydroxy-beta-methylbutyrate were combined in a dietary supplement. This specialized amino acid mixture enhances wound collagen accumulation and increases wound healing. We aimed to investigate the effects of this special amino acid mixture on the healing process of experimental left colonic anastomosis. M Ma at te er ri ia al l a an nd d M Me et th h--o od ds s: : The study included 20 adult male Wistar-Albino rats. The study group (n=10) received 685 mg/kg/day specialized amino acid mixture for 7 days until 12 h before surgery and was maintained throughout the study. Following midline laparatomy a 1-cm segment of the left colon was resected. Bowel continuity was restored with an end-to-end anastomosis. The animals were re-anesthetized on day 7 after the operation and anastomotic bursting pressure was measured by passing a catheter per anum up to the area of anastomosis. Anastomotic segments were removed en bloc and were vertically divided into two. One was used for hydroxyproline measurement and the other for histopathological examination. Abramov's histologic scoring system was used in this study. R Re es su ul lt ts s: : The hydroxyproline levels and bursting pressures in the study group were superior compared to the control group. Collagen deposition and reepithelization scores of the study group were higher than that of the control group. C Co on nc cl lu us si io on n: Results of the present study indicates that significantly enhancing the anastomotic bursting pressure, hydroxyproline level and collagen deposition may improve anastomosis healing.K Ke ey y W Wo or rd ds s: : Colorectal surgery; arginine; glutamine; beta-hydroxyisovaleric acid Ö ÖZ ZE ET T A Am ma aç ç: : Arjinin, glutamin ve beta-hidroksi-beta-metilbütirat, diyet desteği olarak kombine edilmiştir. Bu özel amino asit karışımı, yara yerinde kollajen birikimini artırır ve yara iyileşmesini geliştirir. Bu çalışmanın amacı, deneysel sol kolon anastomozunun iyileşmesinde özel amino asit karışımının etkilerini araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmada 20 adet yetişkin Wistar-Albino sıçan kullanıldı. Çalışma grubu (n=10) ameliyattan 7 gün öncesinden başlayarak tüm çalışma süresince 685 mg/kg/gün özel amino asit karışımı aldı. Orta hattan karın açıldı ve 1 cm'lik sol kolon segmenti rezeke edildi. Uç-uca anastomoz yapılarak barsak lümeninin devamlılığı sağlandı. Sıçanlara bu ameliyattan 7 gün sonra tekrar anestezi verildi. Anastomoz patlama basıncı, anüsten yerleştirilip anastomozun üzerine çıkan bir kateter ile ölçüldü. Anastomoz sahaları sağlam sınırlarla çıkarıldı ve dikey olarak iki parçaya bölündü. Bir parça hidroksiprolin ölçümünde, diğer parça histolojik değerlendirmede kullanıldı. Histolojik değerlendirme için Abramov'un skorlama sistemi kullanıldı. B Bu ul lg gu ul la ar r: : Hiroksiprolin düzeyleri ve patlama basınçları çalışma grubunda, kontrol grubuna göre daha yüksekti. Kollajen birikimi ve reepitelizasyon skorları ç...

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

“…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 ]. Reepithelialisation of necrotic ulcers at the suture line, and deeper crypts, were also major findings in the study by Aguilar and colleagues (1997) [ 28 ] into the effects of intraoperative SCFA lavage on anastomotic healing in rats with colonic obstruction (IAH).…”

“…In case there was any mentioning of blinding (7 studies, 37%), this usually concerned blinding of an outcome assessor handling the histologic evaluation. Only one study [ 40 ] explicitly mentioned blinding for all outcomes. None of the studies reported power/sample size calculations to justify their experimental group sizes.…”

“…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.…”

“…After removing duplicates, 322 records remained. Title and abstract screening yielded 23 studies, of which 18 [7,9,10,16,[26][27][28][29][30][31][32][33][34][35][36][37][38][39] were included for this review after reading the full-text; one additional article [40] was later found through scrutinising cross-references, resulting in a total of 19 included studies containing 41 individual comparisons (Fig 1).…”

“…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.…”