title: Early postoperative enteral feeding increases anastomotic strength in a peritonitis model.
abstract: BACKGROUND
  Tumor necrosis factor alpha (TNF-alpha) has been shown to decrease collagen synthesis and increase collagenase activity leading to impaired wound healing. Our hypothesis was that immediate postoperative feeding would decrease TNF-alpha, therefore increasing anastomotic healing in a peritonitis model.
  
  
  METHODS
  Twelve Sprague-Dawley rats underwent cecal ligation and puncture to induce peritonitis. Six hours after induction of peritonitis an ileocecectomy and ileocolostomy was performed. Group 1 animals (n = 6) had immediate access to food and water, whereas group 2 (n = 6) had free access to water only. At 48 hours, weight loss, nitrogen loss, anastamotic bursting strength (ABS), TNF-alpha, interleukin-6 (IL-6), and IL-10 were measured.
  
  
  RESULTS
  Weight loss was similar in the two groups. Group 1 rats had a significantly lower mean TNF-alpha level (17.3 +/- 10 versus 17.3 +/- 10 mcg/Dl, P = 0.05). ABS was also significantly higher in group 1 rats when compared with group 2 rats (81 +/- 34 versus 39 +/- 13 mm HG, P = 0.03).
  
  
  CONCLUSIONS
  These data suggest that immediate postoperative feeding results in a beneficial change in the cytokine profile.
authors.affiliation: Cedars-Sinai Research Institute, Department of Surgery, Cedars-Sinai Medical Center, and UCLA School of Medicine, Los Angeles, CA 90048, USA. t.Khalili@cshs.org
authors.forename: T M
authors.initials: TM
authors.lastname: Khalili
authors.forename: R A
authors.initials: RA
authors.lastname: Navarro
authors.forename: Y
authors.initials: Y
authors.lastname: Middleton
authors.forename: D R
authors.initials: DR
authors.lastname: Margulies
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D004195:Disease Models, Animal; D004750:Enteral Nutrition; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010538:Peritonitis / Q000601:surgery*; D011184:Postoperative Period; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*; D014945:Wound Healing / Q000502:physiology
chemical_list: D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10