Search

Purpose/Background: It is well recognised that patients following long course chemoradiotherapy can have a complete clinical response. This offers the possibility for organ preservation. However these patients require intense surveillance which commonly involves frequent MRI scans and flexible sigmoidoscopy. LumenEye is a state of the art endoscopic kit, which allows a convenient, comfortable and efficient way of visualising the ano-rectal area in OPD with high quality images avoiding the need for a formal endoscopic procedure. Methods/Interventions: The device includes (a) LumenEye X1 endoscope (b) Tablet display with full HD screen (c) Intuitive CHiP software and (d) Portable case with workstation. The kit displays full HD images and can capture videos. Results/Outcomes: We have used the LumenEye X1 endoscope to survey patients following a complete clinical response who have opted for organ preservation. It avoids the need for an endoscopy and detailed images and videos can be shared with specialist centres. This has been of particular benefit during the Covid 19 pandemic where there has been a limited endoscopy resource. The technology also has other applications such as the intraoperative assessment of left sided colonic anastomosis. Conclusion/Discussion: LumenEye X1 endoscope offers an alternative to the use of endoscopy in the surveillance of patients with a complete clinical response. It also has the potential to free up valuable endoscopy resources.

Summary. The aim of the study. To improve the results of patients with tumors and non-neoplastic diseases of the colon treatment, to introduce into clinical practice the original surgical technique and methods of creating of colon anastomoses, which were tested in experiment. Materials and methods. Original methods of invaginational ileo-transverse and colon anastomoses creating were developed in the experiment on rabbits. Taking into account the obtained positive results, the methods of anastomoses formation were transferred to the surgical clinic and patents of Ukraine were obtained. In 2020, ileo-transverse and colonic anastomoses were formed in 134 patients on the basis of Transcarpathian Antitumor Center: one-row invaginational anastomosis according to the developed method in 22 patients (16.4 %), two-row manual — in 58 (43.3 %), circular stapler — in 36 (26.9 %), linear stapler anastomosis — in 4 (3 %), laparoscopic (linear stapler) — in 14 (10.4 %). Results and discussion. The most of complications occurred in the group with manual two-row anastomosis (16), in two cases the anastomotic leakage was recorded. When using a circular stapler suture, anastomotic leakage was observed in 1 patient, and anastomositis — in 4. When using linear stapler anastomoses, postoperative wound suppuration was observed in 1 patient. Conclusions. The most of early postoperative complications was observed after using a two-row manual colonic anastomosis (27.5 %). When using a circular stapler suture, the number of early postoperative complications was less than with a two-row manual anastomosis (22.2 % vs. 27.5 %, respectively). The least number of complications was recorded after the creation of a one-row invaginational anastomosis in the proposed original technique.

Objective: This study aimed at examining whether topical treatment of colon anastomosis with hyaluronic acid can influence the healing of colonic anastomosis in rats treated with systemic corticosteroid. Methods: Three groups of Wistar rats weighing 252 ± 7g were used, with six rats each, all submitted to anastomosis of the proximal colon: Group 1 - control rats, without treatment. Group 2 - rats treated with subcutaneous (s.c) corticosteroid, and topical application of 0.9% saline solution over the anastomosis. Group 3 - rats treated with corticosteroid s.c. and topical application of 0.4% hyaluronic acid (10 mg/ml) on colonic anastomosis. On the 7th postoperative day, under anesthesia and laparotomy, the anastomosis site was subjected to the determination of rupture pressure. Then, samples containing the anastomosis site were resected and fixed in 10% buffered formaldehyde and embedded in paraffin. Masson H-E and trichrome staining. Histometry evaluated the infiltration of inflammatory cells at the anastomosis site, using a numerical scale from 0 to 4. Continuous variables were assessed using the Tukey test. Differences considered significant with p0.05). In the analysis of intraluminal pressure of colonic anastomosis, there was a statistically significant difference when comparing groups 1 (286.8±9.9 mmHg) and 2 (155±6.0 mmHg), 1 (286.8±9,9 mmHg) and 3 (199.1±7.7) and 2 (155±6.0 mmHg) and 3 (199.1±7.7), with p

A quitosana, polissacarídeo linear obtido a partir do exoesqueleto de crustáceos e artrópodes, tem sido pesquisada em Odontologia por suas diversas propriedades terapêuticas. O objetivo do presente estudo foi realizar uma revisão da literatura sobre as aplicações atuais e as possibilidades terapêuticas da quitosana na odontologia. A busca foi realizada através do banco de dados eletrônico do Pubmed, utilizando os descritores Quitosana, Odontologia e Biomateriais. Foram incluídas pesquisas científicas utilizando quitosana em diversas áreas da odontologia e excluídas revisões de literatura e estudos não odontológicos, sendo selecionados 13 artigos. A quitosana induz resposta transcricional e anti-inflamatória em fibroblastos gengivais sobre citocinas inflamatórias, fatores transformadores do crescimento (TGF -β) e fatores de crescimento tumoral (TNF-α) que estão diretamente relacionados à atividade patológica periodontal. Nas infecções endodônticas persistentes, a substância atua criando ligações de hidrogênio e liberação de íons cálcio, o que potencializa a ação dos irrigadores intracanal, além de causar menos estresse oxidativo. Para a odontologia restauradora, a quitosana demonstrou eficácia como auxiliar no condicionamento da dentina e mostrou potencial para induzir a migração de odontoblastos na proteção do complexo dentino-pulpar. A substância atua como uma cura de feridas orais devido à sua capacidade de estimular a formação de fibroblastos e novos vasos sanguíneos, além de células anti-inflamatórias. Descritores: Biopolímeros; Biomateriais; Biotecnologia. Referências Zhao X, Li P, Guo B, Ma PX. Antibacterial and conductive injectable hydrogels based on quaternized chitosan-graft-polyaniline/oxidized dextran for tissue engineering. Acta Biomater. 2015;26:236-48. Tomihata K, Ikada Y. In vitro and in vivo degradation of films of chitin and its deacetylated derivatives. Biomaterials. 1997;18(7):567-75 Citgez B, Cengiz AN, Akgun I, Uludag M, Yetkin G, Bahat N, Ozcan O, Polat N, Akcakaya A, Karatepe O. Effects of chitosan on healing and strength of colonic anastomosis in rats. Acta Cir Bras. 2012;27(10):707-12. Azevedo VVC, Chaves SA, Bezerra DC, Lia Fook MV, Costa ACFM. Quitina e Quitosana: aplicações como biomateriais. Rev Eletr Mater Proc. 2007;2(3):27-34. Tavaria FK, Costa EM, Pina-Vaz I, Carvalho MF, Pintado MM. A quitosana como biomaterial odontológico: estado da arte. Rev Bras Eng Bioméd. 2013;29(1):110-20. Ueno H, Nakamura F, Murakami M, Okumura M, Kadosawa T, Fujinag T. Evaluation effects of chitosan for the extracellular matrix production by fibroblasts and the growth factors production by macrophages. Biomaterials. 2001;22(15):2125-30. Shahid F, Abuzaytoun R. Chitin, chitosan, and co-products: chemistry, production, applications, and health effects. Adv Food Nutr Res. 2005;49(1):93-135. Croisier F, Jerome C. Chitosan-based biomaterials for tissue engineering. Eur Polym J. 2013;49(1):780-92. Giovino C, Ayensu I, Tetteh J, Boateng JS. An integrated buccal delivery system combining chitosan films impregnated with peptide loaded PEG-b-PLA nanoparticles. Colloids Surf B Biointerfaces. 2013;112(1):9-15. Wieckiewicz M, Boening KW, Grychowska N, Paradowska-Stolarz,U. Clinical Application of Chitosan in Dental Specialities. Mini Rev Med Chem. 2017;17(5):401-9. Ravi Kumar MNV. A análise dos pedidos de quitina e quitosana. R React Funct 2000;46(1):1-27. Chen CK, Chang NJ, Wu YT, Fu E, Shen EC, Feng CW, Wen ZH. Bone Formation Using Cross-Linked Chitosan Scaffolds in Rat Calvarial Defects. Implant Dent. 2018;27(1):15-21 Pavez L, Tobar N, Chacon C, Arancibia R, Martinez C, Tapia et al. Chitosan triclosan particles modulate inflammatory signaling in gingival fibroblasts. J Periodontal Res. 2017; 53(2):232-39. Moraes PC, Marques ICS, Basso FG, Rosseto HL, Pires de Sousa FCP, Costa CAS et al. Repair of Bone Defects with Chitosan- Collagen Biomembrane and Scaffold Containing Calcium Aluminate Cement. Braz Dent J. 2017;28(3):287-95. Aydin UZ, Akpinar KE, Hepokur C, Erdönmez D. Assessment of toxicity and oxidative DNA damage of sodium hypochlorite, chitosan and propolis on fibroblast cells. Braz Oral Res. 2018;32(1):1-8. Özdoğan AI, Ilarslan YD, Kösemehmetoğlu K, Acka G, Kutlu HB, Comerdov E et al. In Vivo Evaluation of Chitosan Based Local Delivery Systems for Atorvastatin in Treatment of Periodontitis. Int J Pharm. 2018;25(1):470-76. Paiola FG, Lopes FC, Mazzi-Chaves JF, Pereira RD, Oliveira HF, Queiroz AM et al. How to improve root canal filling in teeth subjected to radiation therapy for câncer. Braz Oral Res. 2018;32(1):1-9. Farhadian N, Godiny M, Moradi S, Hemati Azandaryani A, Shahlaei M. Chitosan/gelatin as a new nano-carrier system for calcium hydroxide delivery in endodontic applications: Development, characterization and process optimization. Mater Sci Eng C Mater Biol Appl. 2018;92:540-46. Subhi H, Reza F, Husein A, Al Shehadat SA, Nurul AA. Gypsum-Based Material for Dental Pulp Capping: Effect of Chitosan and BMP-2 on Physical, Mechanical, and Cellular Properties. Int J Biomater. 2018;2018:3804293. Soares DG, Anovazzi G, Bordini EAF, Zuta UO, Silva Leite MLA, Basso FG, Hebling J, de Souza Costa CA. Biological Analysis of Simvastatin-releasing Chitosan Scaffold as a Cell-free System for Pulp-dentin Regeneration. J Endod. 2018;44(6):971-76. Işılay Özdoğan A, Akca G, Şenel S. Development and in vitro evaluation of chitosan based system for local delivery of atorvastatin for treatment of periodontitis. Eur J Pharm Sci. 2018;124:208-16. Kesim B, Burak AK, Ustun Y, Delikan E, Gungor A. Effect of chitosan on sealer penetration into the dentinal tubules. Niger J Clin Pract. 2018;21(10):1284-90. Guo JM, Makvandi P, Wei CC, Chen JH, Xu HK, Breschi L, Pashley DH, Huang C, Niu LN, Tay FR. Polymer conjugation optimizes EDTA as a calcium-chelating agent that exclusively removes extrafibrillar minerals from mineralized collagen. Acta Biomater. 2019;90:424-40. Susanto A, Susanah S, Priosoeryanto BP, Satari MH, Komara I. The effect of the chitosan-collagen membrane on wound healing process in rat mandibular defect. J Indian Soc Periodontol. 2019;23(2):113-18.

Background. Repeated surgical interventions aimed at the colostomy closure and restoration of intestinal continuity after obstructive resections are traumatic and complex reconstructive operations on the colon. The complications of recovery operations largely feature wound abscesses (30–60 %) and anastomotic leakage (5–23 %), with the mortality levels from these complications reaching 0.4–2.8 %. Pronounced dysbiotic changes, the progression of catarrhal or erosive diversion colitis and proctosigmoiditis are the risk factors for anastomotic leakage and postoperative bowel dysfunction. This determines the need for a therapeutic algorithm of intestine sanitation and the introduction of methods for preventing the anastomotic leakage after obstructive resection of the distal colon (Hartmann’s operation). Aim. To evaluate the capability and efficiency of the intraluminal application of rifaximin- α (Alfa Normix ® preparation, Alphasigma company) as a sanitising intestinal antiseptic for relieving diversion colitis and prevening postoperative complications of restorative operations after obstructive resection of the colon (Hartmann’s operation). Material and methods. A prospective comparative controlled study of the results of surgical treatment in 63 patients was conducted. The patients were divided into 2 groups, which were compared using the case-control principle. The operations included the colostomy closure and the restoration of intestinal continuity by applying a colonic anastomosis. In group I (main group, 30 patients), the original “Method of postoperative prevention of colonic anastomotic leakage” (Russian patent No. 2523822) was applied. In the control group (33 patients), routine methods for preventing anastomotic leakage and antibiotic prophylaxis were used. A comparative analysis of the number and severity of purulent-septic complications (taking into account the possibility of their relief), as well as the quality and rate of intestinal dysbiosis relief and the manifestations of diversion proctitis, was carried out. Results. The main group indicated the best results in terms of the main analysed parameters, fewer complications and anastomotic leakage. Thus, the total number of complications in groups I and II was 16.7 % and 27.3 %, respectively. The proportion of complications associated with the anastomotic leakage, inflammatory changes in this area and impaired patency in groups I and II was 6.7 % and 12.1 %, respectively. Rifaximin- α (Alpha Normix ® ) intolerance and pathological reactions associated with its use were not observed. The possibility for effective relief of the violations of quantitative and qualitative composition of the microflora in the colon stump was revealed. The main group showed better results in terms of eliminating local manifestations of diversion colitis and anorectal dysfunction compared to group II, where traditional schemes of postoperative therapy were used. Conclusions. Intraluminal dosed use of the Alpha Normix ® suspension with the rifaximin concentration of 100 mg per 5 ml is an effective method of postoperative prevention of purulent-septic complications associated with anastomotic leakage during reconstructive operations on the distal colon. The introduction of Alpha Normix ® in the scheme of postoperative treatment allows its results to be stabilised due to the sanitation of the intestinal lumen, the elimination of dysbiosis, the relief of inflammatory reaction and the elimination of factors supporting the development of diversion proctitis.

Background Colonic capsule endoscopy (CCE) derived from the video capsule endoscopy, initially proposed to explore the small bowel, has demonstrated high sensitivity and specificity for colonic polyp detection. The primary outcome of the study was to assess the safety, feasibility, and reliability of CCE after colorectal surgery. Secondary outcomes were to identify the detection rate of colonic lesions and recognition of the surgical anastomosis as compared to colonoscopy. Methods This is a prospective single-center study conducted over a 2-year period. Thirty-seven patients with a history of colorectal surgery were prospectively included in this study. Each patient received both CCE and colonoscopy, performed by different operators blinded to each other's results. Results Thirty-two patients (86.5%) completed the study and were included in the final analysis. All capsules were naturally expelled. In three patients (9.4%), the anal verge was not identified during the CCE recording and the examination of the colon was considered incomplete. Surgical anastomosis was accurately identified by CCE in 78.2% of the patients versus 93.8% for colonoscopy (P = 0.65). Thirty-eight lesions were detected in 14 patients. The sensitivity of CCE to detect colonic polyps was 95.2% (95% confidence interval (CI): 77.3-99.2%), the specificity 82.4% (95% CI: 59.0-93.8%). Positive predictive value (PPV) and negative predictive value (NPV) of CCE to detect colonic polyps were 87.0% and 93.3%, respectively. No complications related to the passage of the capsule through the intestinal anastomosis were detected. Conclusions CCE proved to be safe and feasible, reporting a similar detection rate of colonic lesion compared to colonoscopy.

Objective — to investigate peculiarities of imposition and strengthening of colonic anastomosis (СА) in patients with insulin resistance (IR) using modern adhesive materials. Material and methods. In order to determine the features of applying and strengthening the colonic anastomosis in patients with IR using modern adhesive materials, 80 patients were examined and operated on (median age of patients — 64 (57; 71) years). All patients were divided into 2 groups depending on the method of reinforcing the suture of the CA: group 1–40 patients who underwent the application of a one-row continuous suture (OCS) of the CA (median age of patients — 65 (57; 75) years, 2 group — 40 patients who OCS CA was applied, and, in order to seal and strengthen the anastomosis zone, a modern tissue adhesive N-butylcyanoacrylate (Katsil) was added (median age of patients — 63.5 (58.5; 70.5) years). The spectrum of the microbial flora of the discharge from the drainages near the anastomosis was determined and the analysis of postoperative complications was carried out. Results. In patients with IR who, in order to additionally strengthen the CA zone after applying OCS, used tissue adhesive H-butylcyanoacrylate, a significantly smaller number of patients with a combination of 2 different strains of microorganisms were found compared with patients who applied OCS CA without additional strengthening (2 (5 (5, 0%) patients versus 9 (22.5%)) (χ2 = 5.17, df = 1; p

Background: This study aimed to characterize the time‐dependent relationship between serum C‐reactive protein (CRP) and anastomotic integrity in the early post‐operative period and to develop a systematic use of CRP and computed tomography. Methods: Patients aged 18 years or over who had the formation of a left‐sided colonic or a colorectal anastomosis, in Royal Sussex County Hospital, were included. The post‐operative day (POD) CRP cut‐off values were calculated according to receiver operating characteristic analysis to evaluate the sensitivities and specificities of the proposed cut‐off parameters. Results: A total of 125 left‐sided colonic and colorectal anastomoses were recruited and analysed. When comparing to POD1 CRP cut‐off, the calculated CRP ratio cut‐off values of all the rest of PODs (2–5) were highly significant in the laparoscopic group and the overall group (P

Aim:Anastomotic leakage in colon anastomosis (CA) increases morbidity and mortality. Calcium dobesilate (CaD) has angioprotective, antioxidant, lymphatic flow enhancing-and neuroprotective effects. Despite these capillary and cellular effects, there is no data in the literature regarding the effects of CaD on CA healing.Method:Fifty Wistar-albino rats were randomly divided into five groups. All rats underwent CA after transverse colon transection. CaD was not administered to the control group (Group 1). CaD was administered to the experimental groups (Groups 2, 3, 4 and 5) intraperitoneally or by gavage at doses of 50 or 100 mg/kg/day. CaD was given as a single dose daily during postoperative five days. Bursting pressure values (BPV) and hydroxyproline values (HV) were measured. At the end of istopathological evaluation, polymorphonuclear leukocytes (PNLS), mononuclear leukocytes (MNLS), neovascularization (VS) and collagen fibers (CFS) were scored.Results:CaD increased BPV and HV in experimental groups. We found a decrease in PNLS, MNLS, VS, and an increase in CFS in experimental groups. These increases seemed to be related to the administration doses of CaD. The decreases in PNLS, MNLS and VS were much more evident in Groups 4 and 5 than the other groups. There was no significant difference in terms of VS between experimental groups.Conclusion:We found that CaD not only decreased the pathological parameters of inflammation, but also increased the strength of CA mechanically and biochemically. Although VS reduction seemed to have negative outcomes on CA, we know that CaD inhibits over-expression in angiogenesis. As a result, these effects of CaD appear to be dose-dependent rather than the administration methods.

Objective: Anastomosis on ischemic intestines is a problematic issue in daily surgical routine. In this study, we investigated the potential effects of thymoquinone, zeolite and platelet rich plasma.Material and Methods: Fifty rats were divided into five groups. In the sham group all rats underwent colonic anastomosis without any ischemic insult. Colonic anastomosis was performed after mesenteric ischemia was induced by clamping the superior mesenteric artery in other study groups. In the control group, no medication was given to the rats after ishemic anastomosis. In Zeolite group and thymoquinone group, Zeolite and thymoquinone were applied locally on the anastomosis. In the platelet rich plasma group, platelet rich plasma was applied locally on the anastomosis. All the rats were sacrified on the 10th day. Blood and tissue samples were retrieved.Results: Hydroxyproline levels were not different between the groups. Bursting pressure was higher in the thymoquinone group than the control group. Reepithelization was higher than the zeolite group in the sham and thymoquinone groups. TNF-α and IL 1β levels were significantly higher in the sham group than all the other groups. TNF-α and IL 1β levels were also significantly higher in the thymoquinone, zeolite and platelet rich plasma groups than the control group and higher in the thymoquinone group than the zeolite and platelet rich plasma groups. Inflammation and ischemic necrosis levels were not different between the groups.Conclusion: Our data is suggesting that thymoquinone and platelet rich plasma have positive effects on ischemic anastomosis healing, while thymoquinone has the best results.

Background: Although herbal medicinal products are being used widely throughout the World, beneficial and harmful effects have not been well documented. Our aim was to evaluate the effects of Aloe Vera (AV) on colonic anastomosis healing. Material and methods: 112 albino Wistar rats were randomly assigned into five main groups: preoperative Aloe Vera Group (P), pre- and postoperative Aloe Vera Group (PP), Control Group (C), sham Aloe Vera Group (SA) and Sham Control Group (SC). Groups P, PP, and SA received 1.6 mL/kg per day Aloe Vera by orogastric feeding catheter for 1 month prior to the experiment. Groups P, PP, and C underwent anastomosis of the distal colon, and subgroups (n = 4) of each were sacrificed on postoperative day 3, 7, 14 and 21. Anastomotic bursting pressure, perianastomotic collagen content and histopathological changes were studied. Results: The SC Group had significantly higher ABP when compared with the SA Group (p = 0.0002), although hydroxyproline content showed no difference. When ABP was compared between anastomosis groups, it was found significantly lower in Aloe Vera groups on Day 3 (P3 vs. C3, p = 0.003 and PP3 vs. C3, p = 0.007). Hydroxyproline content was significantly lower in Group PP than Group C, also on Day 3 (p = 0.05). Significant difference was not detected after Day 3 in any of the study parameters. Conclusion: Aloe Vera decreased tissue collagen content in the early postoperative period. It is advisable to call into question the concomitant usage of conventional medicine and the herbal supplements for the surgeons in their clinical practice. Resumo: Fundamentação: Embora os medicamentos à base de plantas sejam amplamente utilizados no mundo inteiro, seus efeitos (benéficos e prejudiciais) não estão bem documentados. Este estudo teve como objetivo avaliar os efeitos da Aloe vera (AV) na cicatrização de anastomoses colônicas. Material e métodos: 112 ratos Wistar albinos foram distribuídos aleatoriamente em cinco grupos principais: AV pré-operatório (P), AV pré e pós-operatório (PP), controle (C), sham AV (SA) e sham controle (SC). Os grupos P, PP e SA receberam AV em uma dose de 1,6 mL/kg por dia por sonda de alimentação orogástrica por 1 mês antes do experimento. Os grupos P, PP e C foram submetidos a anastomose do cólon distal. Subgrupos (n = 4) de cada grupo foram sacrificados no terceiro, sétimo, 14° e 21° dias pós-operatórios. Os seguintes parâmetros foram avaliados: pressão de ruptura anastomótica (PRA), conteúdo de colágeno perianastomótico e alterações histopatológicas. Resultados: O grupo SC apresentou PRA significativamente maior quando comparado ao grupo SA (p = 0,0002), embora o conteúdo de hidroxiprolina não tenha apresentado diferença. Ao comparar a PRA entre os grupos de anastomose, ela foi significativamente menor no terceiro dia nos grupos que usaram AV (P3 vs. C3, p = 0,003 e PP3 vs. C3, p = 0,007). No terceiro dia, o teor de hidroxiprolina foi significativamente menor no grupo PP do que no grupo C (p = 0,05). Após o terceiro dia, não se observou diferença significativa em nenhum dos parâmetros do estudo. Conclusão: O uso de AV diminuiu o conteúdo de colágeno tecidual no período pós-operatório imediato. É aconselhável questionar o uso concomitante da medicina convencional e suplementos fitoterápicos na prática clínica. Keywords: Bowel anastomosis, Colonic anastomosis, Anastomotic bursting pressures, Hydroxyproline level, Aloe Vera, Wound healing, Palavras-chave: Anastomose intestinal, Anastomose colônica, Pressão de ruptura anastomótica, Nível de hidroxiprolina, Aloe vera, Cicatrização de feridas

Simple Summary Efficacy of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) depends on patient selection, tumor type, delivery technique, and treatment parameters such as temperature, carrier solution, type of drug, dosage, volume, and treatment duration. Preclinical research offers a powerful tool to investigate the impact of these parameters and to assists in designing potentially more effective treatment protocols and clinical trials. This study aims to review the objectives, methods, and clinical relevance of in vivo preclinical HIPEC studies found in the literature. In total, 60 articles were included in this study. The selected articles were screened on the HIPEC parameters. Recommendations are provided and possible pitfalls are discussed on the choice of type of animal and tumor model per stratified parameters and study goal. The guidelines presented in this paper can improve the clinical relevance and impact of future in vivo HIPEC experiments. Abstract Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality for patients with peritoneal metastasis (PM) of various origins which aims for cure in combination with cytoreductive surgery (CRS). Efficacy of CRS-HIPEC depends on patient selection, tumor type, delivery technique, and treatment parameters such as temperature, carrier solution, type of drug, dosage, volume, and treatment duration. Preclinical research offers a powerful tool to investigate the impact of these parameters and to assist in designing potentially more effective treatment protocols and clinical trials. The different methodologies for peritoneal disease and HIPEC are variable. This study aims to review the objectives, methods, and clinical relevance of in vivo preclinical HIPEC studies found in the literature. In this review, recommendations are provided and possible pitfalls are discussed on the choice of type of animal and tumor model per stratified parameters and study goal. The guidelines presented in this paper can improve the clinical relevance and impact of future in vivo HIPEC experiments.

Background : Anastomotic leak in the colon is one of the causes of high morbidity and mortality in infectiouscases. The morbidity and mortality rates in patients with colonic anastomotic leakage range from 7–39%.Various efforts have been made to prevent leakage, such as changing suture techniques and using additionalmaterials. Materials such as fibrin glue and amniotic membranes are gaining popularity in the wound healingprocess.Purpose : To compare the use of dry amniotic membrane and fibrin glue in colonic anastomosis inintraperitoneal infection assessed with tissue hydroxyproline level measurement.Method : This study is an experimental. The subjects were divided into 3 groups, group I (anastomosis usinga simple interrupted suture only), group II (anastomosis and was applied with dry amniotic membrane) andgroup III (anastomosis using a simple interrupted sutureand was applied with fibrin glue). The anastomoticsegment was taken and made into homogenate, then measured for the hydroxyproline level.Result : The study was conducted on 27 Wistar rats, male rats that have been aged 10-12 weeks with theweight of 250-300 grams. It was obtained the differences in average levels hydroxyproline in the group I= 2157.41 (± SD = 478.60), group II = 2887.40 (± SD = 688.49) and group III = 2224.59 (± SD = 416.63).ANOVA test at hydroxyproline samples showed that P

BACKGROUND: Anastomotic leakages and adhesions after gastrointestinal tract surgery are still a significant cause of morbidity and mortality. The rate of anastomotic leakage is 3%-8%, whereas the mortality from leakage is over 30%. Intra-abdominal sepsis is a well-known cause of anastomotic leakage. In addition, intra-abdominal adhesion is a major cause of hospital admissions and reoperations and is associated with morbidity and mortality. In this study, we aimed to investigate the effects of a polyurethane membrane on anastomotic healing and intra-abdominal adhesions. METHODS: This study used 32 Wistar albino rats divided into four groups. Standard resection of left colon 2 cm above the peritoneal reflection and colonic anastomosis were performed after causing abdominal sepsis through caecal ligation and perforation. The control groups (1 and 3) received no further treatment. The experimental groups (2 and 4) received the polyurethane membrane around the colonic anastomosis. Burst pressure, hydroxyproline, interleukin-6 (IL-6), nitric oxide (NO), tissue plasminogen activator (tPA), and tumor necrosis factor-alpha (TNF-α) levels were measured, and histopathological characteristics of the anastomosis were analyzed after re-laparotomy. Moreover, adhesion scores were measured. RESULTS: No statistically significant differences were found in the mean burst pressure levels between sacrificed animals on days three and five (p=0.259, p=0.177). When all the groups were compared, no significant difference was observed in the hydroxyproline, NO, and IL-6 levels (p=0.916, p=0.429, p=0.793, p=0.332, p=0.400, p=0.317). However, in groups 2 and 4, the tPA levels were significantly increased by Opsite therapy (p=0.001, p=0.003), and a statistically significant difference was observed in the adhesion scores (p

This prospective observational study evaluated the role of teduglutide, a semisynthetic analogue of glucagon-like peptide-2 (sGLP-2), in reducing the need for parenteral nutrition in adults with short bowel syndrome. One hundred eight patients underwent autologous gastrointestinal reconstruction surgery (AGIRS), and 74 (68.5%) achieved intestinal sufficiency (parenteral nutrition (PN) not restarted by 6 months after its suspension) with standard medical therapy. Patients unable to continue decreasing PN volume for 6 months were evaluated (with colonoscopy and laboratory investigations) to start sGLP-2. Seventeen patients were started on sGLP-2. The most common underlying aetiology (42.8%) was intestinal ischaemia. Some patients could not start treatment due to active malignancies, preneoplasm, inflammatory bowel disease or lack of insurance. The mean volume of PN at the beginning of sGLP-2 treatment was 12.1±3.9 L/week. Twelve of 17 patients started sGLP-2 between 2014 and 2018, of whom 8 discontinued PN in a mean time of 25.8 weeks. One restarted PN due to renal lithiasis and renal impairment. Seven remained independent of PN at the time of publication. Of these, three patients had postoperative intestinal length (ligament of Treitz to ileocaecal valve or colonic anastomosis) of less than 50 cm and four had postoperative intestinal length of 51–99 cm. All patients who weaned PN had partial or total …

PURPOSE Colorectal cancer is globally the third most common cancer. Anastomotic complications remain to be an important issue for colorectal surgery. The aim of this study was to investigate the protective effects of thymoquinone (TQ) on the healing process of left colonic anastomosis in an experimental model. METHODS Thirty-two male rats were divided into two groups, as the TQ group and the control group. TQ was administered to the TQ group, whereas the control group was given a standard feed and water for 2 wk. Following the creation of a left colonic anastomosis, subjects in both groups were sacrificed on the postoperative (PO) third and seventh days. Anastomotic burst pressures were measured mechanically. Immunohistochemical stainings for proliferating cell nuclear antigen, cluster of differentiation (CD) 31, CD45 were performed, and the matrix metalloproteinase-2 levels were measured. Histologic total scores were calculated according to Ehrlich-Hunt model. A value of P

Short bowel syndrome is a rare surgical complication associated with high morbidity and mortality, significant decrease in quality of life and increasing costs to the healthcare system. In some cases, this condition can be mitigated and even reversed if the intestinal transit is restored with a minimum of 75-100 centimeters of small intestine and a segment of the colon. Some of the surgical techniques available within autologous gastrointestinal reconstruction are Serial transverse enteroplasty (STEP), Longitudinal intestinal lengthening (LILT), and as a last resort, intestinal transplantation. We presented a case of intestinal failure due to type I short bowel syndrome who improved in clinical stage from D4 to D2 after intestinal continuity restitution was performed with a jejuno-colonic anastomosis.

BACKGROUND: The present study aims to evaluate the use of the chlorhexidine gluconate and metronidazole impregnated compresses concerning anastomosis safety in the left colonic anastomosis in the presence of peritonitis. METHODS: This study was conducted on 21 Wistar-Albino-rats divided into three equal groups. After median laparotomy, the whole layer of the left colon was cut 2 cm over the pelvic peritoneum. The faeces were spread around the injury for fecal contamination. Then, fasia and skin were closed with 3/0 silk. After one day period, relaparatomy was performed. The abdomen was cleared isotonic sodium chloride with impregnated material before starting colonic anastomosis in the first group and then double layer colonic anastomosis was performed. In the second Group-II, abdomen was cleared with the metronidazole impregnated compresses then double layer colonic anastomosis was performed. In the group-III, abdomen was cleared with the chlorhexidine gluconate impregnated compresses then double layer colonic anastomosis was performed. Tissue hydroksiproline levels and anastomosis bursting pressures were measured and histopathologic findings on the anastomosis line were evaluated on the postoperative tenth day by performing relaparatomy. RESULTS: The highest anastomosis bursting pressure was found in Group-III (p

WOS: 000498463800022 PubMed: 31448554 Hyperthermic intraperitoneal chemotherapy (HIPEC) has cytotoxic effects on tumour cells but also negative impacts on anastomotic healing. Platelet-rich-plasma (PRP) is used for wound care but data about effects on gastrointestinal anastomosis are limited. In this experimental study, we aimed to investigate the effects of PRP application on colon anastomosis in rats those received HIPEC with cisplatin. Five rats were sacrificed to obtain PRP gel. Thirty rats were divided into three groups; Group 1: control group, Group 2: colon anastomosis and HIPEC with cisplatin, and Group 3: colon anastomosis enhanced by PRP and HIPEC with cisplatin. The rats were re-operated on postoperative day seven and anastomotic bursting pressure (ABP) was recorded. Also, tissue samples were taken for hydroxyproline assessment and histopathological examination. There were significant differences in ABP between Groups 2 and 3, and also those groups had lower ABP compared with the control group. Group 3 had significantly higher hydroxyproline levels and had better histopathological findings than group 2. According to our findings, we suggest that PRP application improves the anastomotic healing by increasing anastomotic bursting pressure, hydroxyproline levels, and decreasing inflammatory response. Further clinical studies are needed to prove our hypothesis. Samsun Research and Training Hospital Resources

The risk of complications and mortality are high after enteroenterostomy in severe peritonitic conditions. Magnetic compression anastomosis (MCA) is a sutureless technique of high efficacy and safety. The purpose of this study was to compare the efficacy of MCA for enteroenterostomy with stapled and hand-sewn techniques under peritonitic conditions.The peritonitic conditions were created by puncturing the colon with a circular blade in 27 mongrel dogs. Eight hours later, the peritoneal cavity was washed with warm, sterilized normal saline solution. The animals were then randomly divided into three groups and underwent colonic anastomosis with MCA, stapled, or hand-sewn techniques, respectively. Animals were euthanized at 1, 2, and 4 w after the operation; anastomoses were compared on the basis of gross appearance and histology.All magnetic devices formed patent anastomoses without a leak. However, one stapled anastomosis and three hand-sewn anastomoses resulted in leaks. The anastomosis time was significantly less in the MCA group than that of the other two groups (P 0.05). All magnetic devices were expelled naturally. The pathologic observation showed that the healing of anastomoses for MCA was smoother than that of the other two groups.MCA is a feasible, safe, and effective alternative for enteroenterostomy under peritonitic conditions in the canine model.

Background: There is no evidence that bowel rest and a period of starvation are beneficial for healing of gastrointestinal anastomosis. Aim of work: This study assesses the outcomes of early oral feeding compared with the 5 days delay after small and large bowel anastomosis. Patients and methods: This study included 40 patients with either small intestinal or colonic anastomosis randomly divided into two groups (20 patients each). Group I patients were managed traditionally with 5 day delay before oral feeding, while those of group II were allowed oral fluids once there was audible intestinal sounds or passage of flatus. Results: There was no significant difference comparing both groups as regards gender and age distribution, cause and type of surgery and occurrence of intestinal fistula. There was a significant lower incidence of wound complications in group II with shorter hospital stay. Conclusion: Early oral feeding after gastrointestinal anastomosis is safe, effective, well tolerated and beneficial to all patients.

BackgroundWe sought to investigate contemporary management of anastomosis leakage (AL) after colonic anastomosis.MethodsThe American College of Surgeons National Surgical Quality Improvement Program database 2012 to 2013 was used to identify patients with AL. Multivariate regression analysis was performed to find predictors of the need for surgical intervention in management of AL.ResultsA total of 32,280 patients underwent colon resection surgery with 1,240 (3.8%) developing AL. Overall, 43.9% of patients with AL did not require reoperation. Colorectal anastomosis had significantly higher risk of AL compared with ileocolonic anastomosis (adjusted odds ratio [AOR], 1.20; P = .04). However, the rate of need for reoperation was higher for AL in colocolonic anastomosis compared with ileocolonic anastomosis (AOR, 1.48; P = .04). White blood cell count (AOR, 1.07; P < .01), the presence of intra-abdominal infection with leakage (AOR, 1.47; P = .01), and protective stoma (AOR, .43, P = .02) were associated with reoperation after AL.ConclusionsNonoperative treatment is possible in almost half of the patients with colonic AL. The anatomic location of the anastomosis impacts the risk of AL. Severity of leakage, the presence of a stoma, and general condition of patients determine the need for reoperation.

AIM to assess results of stapling anastomosis in colorectal surgery. PATIENTS AND METHODS. The results of surgical treatment of 427 patients with rectal cancer and 458 patients with colon cancer (T1-4N0-2M0-1) were analyzed. A circular stapler was used to perform end-to-end (347patients) and side-to-end (80 patients) anastomosis. 164 patients underwent stapling colonic anastomosis. RESULTS. Anastomotic leak rate after stapled colorectal anastomosis was 8,7% (n=37) and was lower after side-to-end anastomosis 3,8% (n=3). Anastomotic leakage developed in only 2 (1,2%) patients after colon anastomosis. CONCLUSION. Proper use of stapling devices and proper surgical technique allow to create reliable anastomosis which safety is comparable the manual one.

Background and Objective Colonic anastomotic failure is a dreaded complication, and multiple surgical techniques have failed to eliminate it. Photochemical tissue bonding (PTB) is a method of sealing tissue surfaces by light-activated crosslinking. We evaluated if a human amniotic membrane (HAM), sealed over the anastomotic line by PTB, increases the anastomotic strength. Study Design Sprague–Dawley rats underwent midline laparotomy followed by surgical transection of the left colon. Animals were randomized to colonic anastomosis by one of the following methods (20 per group): single-layer continuous circumferential suture repair (SR); SR with a HAM wrap attached by suture (SR+ HAM-S); SR with HAM bonded photochemically over the anastomotic site using 532 nm light (SR+ HAM-PTB); approximation of the bowel ends with only three sutures and sealing with HAM-PTB (3+ HAM-PTB). A control group underwent laparotomy alone with no colon resection (NR). Sub-groups (n = 10) were sacrificed at days 3 and 7 post-operatively and adhesions were evaluated. A 6 cm section of colon was then removed and strength of anastomosis evaluated by burst pressure (BP) measurement. Results A fourfold increase in BP was observed in the SR+ HAM-PTB group compared to suture repair alone (94 ± 3 vs. 25 ± 8 mm Hg, P

The purpose of this study was to perform the clinical, histopathologic and biochemical evaluation of the effects of intraperitoneally (IP) administered dexpanthenol (dxp) on colonic anastomosis healing in rats. The study was conducted on a total of 28 rats divided into four groups comprising seven rats each. Group I was designated as the control group, group II as the dxp group, group III as the anastomosis group, and group IV as the anastomosis + dxp group. The groups were compared in terms of intestinal bursting pressure, adhesion formation, nitric oxide (NO) and malondialdehyde (MDA) levels, total antioxidant capacity (TAC) and total oxidant capacity (TOC) in blood and intestinal homogenates, as well as histopathologic findings. Dxp decreased adhesion formation (6 rats in group III and 4 rats in group IV). Mean bursting pressures were higher in the dxp groups than in the other groups (group II = 254.3 ± 42.1 mmHg, group IV = 109.3 ± 34.5 mmHg). Moreover, there was a remarkable decrease in the levels of NO and MDA and in blood oxidative stress parameters in the dxp groups. The results suggest that dxp increased intestinal bursting pressure by accelerating healing in the anastomosis line and decreased adhesion formation, positively affecting healing. Dexpanthenol, which was found to have positive effects in the experimental rat model, can be introduced into clinical practice.

Colorectal anastomotic leakage is one of the most feared and fatal complications of colorectal surgery. To date, no external coating material that can prevent anastomotic leakage has been developed. As myoblasts possess anti-inflammatory capacity and improve wound healing, we developed a multilayered human skeletal muscle myoblast (HSMM) sheet by periodic exposure to supraphysiological hydrostatic pressure during repeated cell seeding. We assessed whether the application of an HSMM sheet can promote the healing process after colonic anastomosis. Partial colectomy and insufficient suturing were employed to create a high-risk colo-colonic anastomosis model in 60 nude rats. Rats were divided into a control group ( n = 30) and an HSMM sheet group ( n = 30). Macroscopic findings, anastomotic bursting pressure, and histology at the colonic anastomotic site were evaluated on postoperative day (POD) 3, 5, 7, 14, and 28. The application of an HSMM sheet significantly suppressed abscess formation at the anastomotic site compared to the control group on POD3 and 5. The anastomotic bursting pressure in the HSMM sheet group was higher than that in the control group on POD3 and 5. Inflammatory cell infiltration in the HSMM sheet group was significantly suppressed compared to that in the control group throughout the time course. Collagen deposition in the HSMM sheet group on POD3 was significantly abundant compared to that in the control group. Regeneration of the mucosa at the colonic anastomotic site was promoted in the HSMM sheet group compared to that in the control group on POD14 and 28. Immunohistochemical analysis demonstrated that surviving cells in the HSMM sheet gradually decreased with postoperative time and none were detected on POD14. These results suggest that the application of a multilayered HSMM sheet may prevent postoperative colonic anastomotic leakage.

Intestinal anastomoses are commonly performed in both elective and emergent operations. Even so, anastomotic leaks are a highly feared complications of colonic surgeries and can occur in up to 26% of surgical anastomoses, with mortality being up to 39% for patients with such a leak. Currently, there remains a paucity of data detailing the cellular mechanisms of anastomotic healing. Devising preventative strategies and treatment modalities for anastomotic leak could be greatly potentiated by a better understanding of appropriate anastomotic healing. A murine model is ideal as previous studies have shown that the murine anastomosis is the most clinically similar to the human case as compared with other animal models. We offer an easily reproducible murine model of colonic anastomosis in mice that will allow for further illustration of anastomotic healing.

Objective: Symptomatic anastomotic leakage observed after colorectal surgery is one of the major complications. One of the factors affecting the anastomosis healing is the type of suture material used. This study aims to investigate the effects of the suture material polydioxanone (PDS, Ethicon), which is late absorbable and has a monofilament structure, and the suture material polyglactin 910 (Vicryl, Ethicon), which is absorbable and has a multifilament structure, on the healing of colonic anastomosis, and to compare the traditional forms of these sutures with their antibacterial effective triclosan-impregnated forms (PDS Plus, Ethicon and Vicryl Plus, Ethicon). Materials and Methods: The rats were divided into four equal groups consisting of 10 subjects each: Group I: Vicryl; Group II: Vicryl Plus; Group III: PDS; and Group IV: PDS Plus. The presence of wound infection, whether the integrity of the abdominal wall was maintained, intra-abdominal adhesion scoring, the presence of intra-abdominal abscess, and whether the macroscopic integrity of anastomosis was maintained were evaluated. Results: According to the results of this experimental study, while the highest ABP and hydroxyproline levels were observed in the PDS Plus group, the lowest values were observed in the Vicryl group. However, the difference was not statistically significant. Conclusion: Slowly absorbable and monofilament PDS suture material causes less tissue reaction and inflammatory response compared to the Vicryl suture material that is absorbable in the colonic anastomosis line and multifilament.

Objective: Colonic anastomotic leakage represents a complication with high mortality and morbidity. In the present study, it was aimed to examine the effect of the amniotic membrane on the healing of ischemic colonic anastomosis. Methods: 25 pregnant Wistar albino rats aged 19-21 days were randomly divided into 5 groups. With midline laparotomy, pregnancies were terminated, and fresh amniotic membranes were obtained. In Group 1 Sham (S), no procedure except for laparotomy was performed. In Group 2 of colonic anastomosis (A), the descending colon was completely transected and anastomosed. In Group 3 of amniotic anastomosis (AA), the anastomosis line was fixed by being wrapped with the fresh amniotic membrane. In Group 4 of colonic ischemic anastomosis (IA), the marginal arteries were ligated after descending colon transection. Ischemia was induced, and anastomosis was performed. In Group 5 of colonic ischemic anastomosis wrapped with the amniotic membrane (AIA), after ischemic colonic anastomosis was performed, the anastomosis line was fixed by being wrapped with the amniotic membrane. On the postoperative 7th day, rats were sacrificed, and their anastomotic bursting pressures were measured. For histological examination, the colon segment containing the anastomosis line was removed. Hematoxylin-eosin and Van Gieson trichrome stained specimens were histologically evaluated and scored according to the Ehrlich-Hunt model. Results: Anastomotic bursting pressures were measured in group S as the highest, in AA, AIA, A in a decreasing order and in group IA as the lowest. The difference between groups S and AA was statistically insignificant in the paired comparison of groups according to their bursting pressure values (p=0.222). When the other pairs were compared, the difference between the groups was calculated as significant (p< 0.05). According to the Ehrlich-Hunt model, the total score was the highest in AIA group, decreased in AA, IA, A groups in a decreasing order, and was the lowest in group S. A paired comparison for total scores between the groups was statistically insignificant between groups S and A (p=0.222). Other paired comparisons were statistically significant (p< 0.05). Conclusion: Wrapping the colon anastomosis line with the amniotic membrane gave positive results both in the ischemic colon as well as in the non-ischemic colon in terms of bursting pressure and histological anastomosis safety.

Paclitaxel has been used frequently for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for ovarian carcinomatosis. Cytoreductive surgery and HIPEC are associated with high rates of morbidity being anastomotic dehiscence one of the most frequent. The objective of this study is to quantify the effect of Paclitaxel-based HIPEC on colonic anastomosis in an experimental rat model. After left colon resection and anastomosis, animals were randomized into four groups: Controls (C); Hyperthermia (H); Normothermic Intraperitoneal Paclitaxel (CP) and Paclitaxel-based HIPEC (HP). On postoperative day four, animals’ peritoneal cavities were examined macroscopically, colon anastomosis burst pressures measured and specimens analyzed histologically. Thirty-nine animals were randomized and 36 were included in the analysis. H group presented the highest burst pressure 105.11 ± 22.9 mmHg, which was 27% higher than C (77.89 ± 27.6 mmHg). On the other hand, HP presented the lowest burst pressure 64 ± 26 mmHg, 16% lower than C group and 39% lower than H, being this latter difference statistically significant (p = 0.004). There were no significant differences regarding weight loss, adhesion scores, perianastomotic abscesses and histological findings (inflammation, fibroblasts, neoangiogenesis, and collagen among groups). Strength of colonic anastomosis was improved by isolated hyperthermia and negatively affected by Paclitaxel-based HIPEC.

The aim of this study was to investigate the effect of platelet-rich plasma (PRP) on the healing of colonic anastomosis in the presence of sepsis.Fifty Wistar-albino male rats were used. Ten healthy rats were euthanized to prepare PRP, the rest were subjected to colonic anastomosis and randomly allocated into four groups of 10 rats each as anastomosis without PRP (C), without PRP in sepsis (SC), anastomosis with PRP (C-PRP), and with PRP in sepsis (S-PRP). Sepsis was induced by cecal ligation and puncture procedure. All animals were euthanized on postoperative day 7. The body weight change, anastomotic bursting pressure (ABP), tissue hydroxyproline (TH) and histopathological examination of each group were analyzed by using one-way analysis of variance (ANOWA) and Tukey's HSD post-hoc test to assess the differences between the groups.There was no statistical difference among the groups in terms of body weight changes. The ABP was measured at a mean value of 179.5 ± 10.3, 129.3 ± 14.2, 209 ± 14.4, and 167.5 ± 7.5 mm-Hg, in group C, SC, C-PRP, and S-PRP, respectively. The ABP and TH of C-PRP group was significantly higher than three groups (p.05, for each comparison). In sepsis, PRP significantly raised the mean ABP and TH levels up to the levels of C group. Tissue regeneration was significant with increased collagen formation in C-PRP group than the other groups (p.05). The healing effect of PRP in the presence of sepsis was significant than S-group (p.05), while similar to C group (p = .181).PRP application to colonic anastomosis promotes the healing process in rats with intra-abdominal sepsis.

Anastomotic leak is considered the major complication following abdominal surgery. In recent years, the use of a variety of sealing materials for the prevention of leaks has been analyzed. Different biomaterials have been employed as scaffolds to favour tissue repair and regeneration. Among these materials we must mention alginate, a natural polymer with different applications as temporary supporting matrix. The aim of the present study is to evaluate the behavior of both alginate-impregnated sutures and lyophilized alginate sponges in the healing process of colonic anastomes using an experimental animal model.A preliminary study was undertaken to select the adequate scaffold. Animals (n = 45) were distributed into three groups: control (colonic anastomosis using non-continuous 5-0 Polyglactin 910 suture), suture (colonic anastomosis using suture impregnated with alginate gel at 4%) and sponge (colonic anastomosis using suture reinforced with lyophilized alginate sponge). The macroscopic and histological variables were assessed at 4, 8 and 12 days after surgical intervention.No statistically significant differences have been observed between the groups during the analysis of macroscopic variables. Animals with sponge implantation showed a greater degree of epithelial reepithalization, less acute and chronic inflammation and greater collagen deposit.The use of lyophilized alginate sponges to reinforce colonic anastomoses in an animal model reduces inflammation and promotes the earlier formation of greater collagen deposits without increasing the number of adhesions or the incidence of stenosis.

Cancer patients treated with radiotherapy (RT) could develop severe late side effects that affect their quality of life. Long-term bowel complications after RT are mainly characterized by a transmural fibrosis that could lead to intestinal obstruction. Today, surgical resection is the only effective treatment. However, preoperative RT increases the risk of anastomotic leakage. In this study, we attempted to use mesenchymal stromal cells from adipose tissue (Ad-MSCs) to improve colonic anastomosis after high-dose irradiation. MSCs were isolated from the subcutaneous fat of rats, amplified in vitro, and characterized by flow cytometry. An animal model of late radiation side effects was induced by local irradiation of the colon. Colonic anastomosis was performed 4 wk after irradiation. It was analyzed another 4 wk later (i.e., 8 wk after irradiation). The Ad-MSC-treated group received injections several times before and after the surgical procedure. The therapeutic benefit of the Ad-MSC treatment was determined by colonoscopy and histology. The inflammatory process was investigated using Fluorine-182-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography and Computed Tomography (18F-FDG-PET/CT) imaging and macrophage infiltrate analyses. Vascular density was assessed using immunohistochemistry. Results show that Ad-MSC treatment reduces ulcer size, increases mucosal vascular density, and limits hemorrhage. We also determined that 1 Ad-MSC injection limits the inflammatory process, as evaluated through 18F-FDG-PET-CT (at 4 wk), with a greater proportion of type 2 macrophages after iterative cell injections (8 wk). In conclusion, Ad-MSC injections promote anastomotic healing in an irradiated colon through enhanced vessel formation and reduced inflammation. This study also determined parameters that could be improved in further investigations.

Background Magnetic compression technique (MCT) is useful for construction of digestive tract anastomoses in pigs and dogs. This study determined the efficacy of MCT for performing colonic anastomosis in rats. Methods Twenty male Sprague–Dawley rats (230-280 g) were randomly apportioned to a study group that underwent colonic anastomosis with MCT or a control group subjected to hand-sewn colonic anastomosis. The groups were compared for time to construct the anastomosis, survival rate, and postoperative complications. Animals were euthanized at 1 mo postsurgery to study the burst pressure and histology of the anastomoses. Results The study group required significantly less time to construct the anastomosis (6.50 ± 1.58 min) than did the control (15.6 ± 2.22 min). The survival rate of the study group (100%) was significantly higher than that of the control group (60%). In the control group, three rats developed anastomotic leakage and one rat developed anastomotic obstruction. No anastomotic leakage or obstruction was observed in the study group. The burst pressures of the two groups were similar. Histology showed that the study group had better alignment of the tissue layers and less inflammation compared with the control group. Conclusions MCT is a safe and feasible technique for colonic anastomosis in rats, with better postoperative outcomes compared with hand-sewn anastomosis.

Background: Up to 20% of patients with colorectal cancer present with obstruction. The goal of this study was to compare the short-term outcomes of patients with obstructing colon cancer who underwent resection and primary anastomosis with or without proximal diversion. Objective: This study was carried out in Surgery Department of Zagazig University Hospitals from February 2000 to February 2018 to compare the on-table irrigation and primary anastomosis versus proximal diversion with loop proximal diversion. Patients and methods: This study comprised 2525 patients who were divided into 2 groups: Group A included 2322 patients who have undergone on table lavage and primary anastomosis. Group B included 203 patients who have undergone primary anastomosis with proximal ileostomy. In our study, 1431 patients were males and 1094 patients were females. All patients were well prepared and investigated for selection of patients who can be operated. All patients were operated and discharged from the hospital and followed up in outpatient clinic of Zagazig University Hospitals, Surgery department. Results: As regard the age, there was a highly significant difference in the age of the two groups (p=0.004) while there was no significance in the sex of the studied groups (p=0.61). As regard the tumor location there was no significance (p=0.298). The intraoperative time was increased in case of on table irrigation with a significant difference (p=0.001). There was also a significant difference in the postoperative hospital stay (p=0.001). There was no significance regarding the postoperative complications of the studied groups expect stoma complications in case of diversion (p=0.001). Conclusion: On table colonic lavage and primary anastomosis is favored in surgical management of acute obstructed left sided colon cancer in low risk patients while in high risk older patients primary anastomosis with a covering stoma is preferred for fear of leakage and a covering loop ileostomy is preferred than loop colostomy.

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.

Background Many centers use the Pringle's maneuver during liver resections. Since this maneuver might impair healing of bowel anastomoses, we evaluated its influence on the healing of colonic anastomosis in rats. Methods Male Wistar rats underwent median laparotomy and sigmoid resection with end-to-end anastomosis under inhalation anesthesia. Thereafter, rats received a 25 minutes Pringle's maneuver (PM, group 1) or were kept under anesthesia for the same period of time (group 2). The anastomotic bursting pressure (BP) was measured on postoperative days (POD) 3, 6 and 9. Hematoxylin and Eosin (H&E) staining was used for histopathological evaluation of the anastomosis. The Mann-Whitney U and χ2 -tests were used, p Results All animals (n=48) lost body weight (BW) until POD3 (95.2% vs. 85.7%, p=0.003), and BW remained lower after PM (106.2% vs. 92.8%, p=0.001). The anastomotic BP was lower in group 1 compared to group 2 on POD 3 (116mmHg vs. 176.28mmHg, p=0.001), POD 6 (182.8mmHg vs. 213mmHg, p=0.029) and POD 9 (197.2mmHg vs. 251.7mmHg, p=0.009), and mortality was higher in group 1 (1 vs. 7, p=0.022). Conclusions Pringle's maneuver increases anastomotic complications in rats. Therefore, a Pringle's maneuver should be avoided during simultaneous liver and colorectal surgery.

Objective : The aim of this study was to assess the safety of early oral feeding after elective colonic anastomosis. Method: The study was conducted upon 40 cases at Kasr Al- Ainy teaching hospital. The cases were divided into two groups: Group 1 (Early feeding): 20 patients began fluids on the first postoperative day and advanced to a regular diet within the next 24–48 h, as tolerated. Group 2 (Regular feeding): 20 patients were managed in the traditional way (nothing by mouth for five days). Results: Anastomotic leakage was 0% in early feeding group versus 5% in conventional feeding group. Early oral feeding was tolerated in 90% of patients in early feeding group. The time to first passage of flatus was sooner in the early feeding group (1.05 ± 0.22) than the traditional group (1.95 ± 1.05), p= 0.001. The risk of wound infection was significantly reduced with the early feeding group (10.0%) when compared with the conventional feeding group (40.0%), p = 0.028. Length of hospital stay was significantly less in the early feeding group. Conclusion: Early oral feeding after elective colonic anastomosis is safe and can be tolerated by the majority of patients. Early oral feeding is associated with early return of bowel habits and reduced length of hospital stay. It is also associated with reduced risk of wound infection.

Introduction: A leak from an intestinal anastomosis is the complication most feared by the colorectal surgeon. The role of omentoplasty in securing colorectal anastomoses shows some controversy: being recommended by some authors, being of equivocal value to others and to be recommend against by a third group of authors. Collagen-bound fibrin sealant sheets have recently been used in many aspects of surgery; for example: Hernia, GI, ophthalmic, gynecologic & obstetric, renal, vascular and cardiac surgeries; and many experimental animal studies proved its efficacy in securing GJ anastomoses. The safety and feasibility of using collagen-bound fibrin sealant has been proven. Its application for sealing colonic anastomosis is a new field of its application and needs to be evaluated. Aim: To evaluate and compare the efficacy of both omentoplasty and a newly introducedfibrin sealant; TachoSil®; in decreasing the rate of anastomotic leakage in colorectal anastomoses. Results: 97 patients were included; 48 in omentoplasty group and 49 in TachoSil® group. The rate of clinical leakage in omentoplasty group was 8.3% and in TachoSil® group was 2%. Three out of four leakages in the omentoplasty group were sever(>500 cc/day) and the only case in TachoSil® group was less sever (