The Effects of Hyperbaric Oxygen Therapy on Experimental Colon Anastomosis After Preoperative Chemoradiotherapy

Abstract

The aim of the present study was to investigate the effect of hyperbaric oxygen therapy (HBOT) on colon anastomosis after chemoradiotherapy (CRT). Sixty female WistarAlbino rats were divided into 5 groups and underwent left colon resection and end-toend anastomosis. CRT simulation was performed on 2 sham groups before the anastomosis, and 1 of these groups was administered additional postoperative HBOT. Two groups were administered CRT before the anastomosis, and 1 of them received additional postoperative HBOT. On postoperative day 5, all groups underwent relaparotomy; burst pressure was measured and samples were obtained for histopathologic and biochemical analysis. There was a significant weight loss in the CRT groups and postoperative HBOT had an improving effect. Significantly decreased burst pressure values increased up to the levels of the controls after HBOT. Hydroxyproline levels were elevated in all groups compared to the control group. Hydroxyproline levels decreased with HBOT after CRT. No significant difference was observed between the groups regarding fibrosis formation at the anastomosis site. However, regression was observed in fibrosis in the group receiving HBOT after CRT. Preoperative CRT affected anastomosis and wound healing unfavorably. These unfavorable effects were alleviated by postoperative HBOT. HBOT improved the mechanical and biochemical parameters of colon anastomosis in rats.Key words: Anastomosis -Chemoradiotherapy -Hyperbaric oxygen -Rat -Burst pressure 2 Although adjuvant therapy has been a well-accepted procedure to prevent metastasis and local recurrence after surgical resection, more recently neoadjuvant therapy has gained popularity to enable secondary curative resection with clear surgical margin and to prolong overall and recurrence-free survival.2 It has been reported that local recurrence rate is lower, toxicity is rare, and the anal sphincter is more likely to be preserved in those undergoing preoperative radiation. 1,2Despite the current advances in surgical techniques, anastomotic leakage is a severe complication leading to morbidity and mortality after intestinal surgery.3-6 Chemoradiotherapy (CRT) has the potential to lead to inadequate vascularization in tissues, a well-known risk factor for intestinal anastomosis leak. Impaired oxygenation as a result of hampered vascularization may lead to delay in wound healing, which ultimately impairs anastomotic durability. Studies on factors that enhance wound healing to prevent anastomotic leakage in colon anastomosis have been accelerated in the past decade. In a limited number of studies performed for this purpose, hyperbaric oxygen therapy (HBOT), which is applied by means of intermittent inhalation of 100% oxygen under 1 atmosphere pressure, has been reported to have favorable effects on intestinal anastomotic healing.7-9 However, whether HBOT can reverse potential side effects of CRT on would healing and anastomotic durability is unclear. The aim of the present study was to investigate the effects of HBOT on the bioche...

Preventing pharyngo‐cutaneous fistula in total laryngectomy: A systematic review and meta‐analysis

“…The rationale of placing prophylactic flaps into the wound to aid healing in the setting of previous radiotherapy is based on the assumptions that hypoxia resulting from the microvascular damage induced by radiation necessarily impairs wound healing, and therefore predisposes to PCF formation, and that the addition of well‐vascularized tissue can to some extent reverse this effect, perhaps through alteration of the local tissue microenvironment. Similar rationale is used to support the use of hyperbaric oxygen therapy and novel tissue‐oxygenation enhancing compounds after surgery in other previously irradiated sites . An alternative is that the flap simply offers mechanical support to the pharyngeal suture line.…”

“…Similar rationale is used to support the use of hyperbaric oxygen therapy and novel tissueoxygenation enhancing compounds after surgery in other previously irradiated sites. 63,64 An alternative is that the flap simply offers mechanical support to the pharyngeal suture line. The precise mechanism(s) by which prophylactic flaps aid wound healing remains unknown.…”

Effect of preconditioning and postoperative hyperbaric oxygen therapy on colonic anastomosis healing with and without ischemia in rats

“…There is some evidence that more intensive protocols, defined as more than one session per day, would yield better results 4,16,[26][27][28] . Maximum pressurization of at least 2.8 ATA 25 or more days of treatment on previous sessions 30 has also been shown to yield better results than more conservative protocols with fewer sessions, longer interval between sessions, or lower final pressurization 8,29 .…”

The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes

“…Since 1991, when Van Der Ham used the first rat model of colorectal anastomosis to test the effect of fibrin glue, hundreds of similar models have examined the efficacy of other potential factors, including hyperbaric oxygen, prokinetics, nonsteroidal anti-inflammatory agents, amino acids, cyanoacrylate. [17][18][19][20] Different techniques and routes to perform the anastomosis and to identify the left colon have been also proposed. The clinical evidence for rupture of the anastomosis was studied initially, then a large number of different techniques to test for microscopic leakage and the anastomotic strength were implemented (biopsies for pathology, collagen concentration and degradation measuring the hydroxyproline, neutrophylic granulocyte infiltration and bursting pressure).…”