Pancreatic islet transplantation prevents the impaired healing of intestinal anastomoses in Lewis rats with streptozotocin-induced diabetes.
Pancreatic islet transplantation may prevent secondary complications of diabetes mellitus, but its potential benefits on early complications have been incompletely examined. The objective of this study was to investigate whether preoperative islet transplantation would normalize impaired healing of intestinal anastomoses in diabetic rats. Male Lewis rats were divided into a control group (I), an uncontrolled diabetic group (II), and a transplant group (III). Nine days before surgery, groups II and III were rendered diabetic by injection of streptozotocin. Two days before surgery, group III received an intrahepatic isogenic two-donor islet graft, whereas groups I and II underwent sham transplantation. On day 0, all animals underwent resection and anastomosis of both ileum and colon. Half of the animals in each group were killed on day 3 and the other half were killed on day 7. Blood glucose levels in group II rats remained over 20 mmol/L throughout the experiment, whereas in group III rats they were normalized within 24 hours after transplantation. At death, group II rats, but not groups I and III rats, showed a high incidence of anastomotic abscesses. Uncontrolled diabetes lowered anastomotic strength, and transplantation prevented this reduction. For instance, anastomotic bursting pressure in the ileum on day 3 was 11.9 +/- 4.8 kPa in group I rats, 3.3 +/- 3.0 kPa in group II rats, and 11.1 +/- 4.3 kPa in group III rats. Rupture on day 3 always occurred within the anastomosis, whereas on day 7 intra-anastomotic ruptures were only observed in group II rats. No differences between the groups were found for either anastomotic hydroxyproline concentration or content. However, the acid solubility of anastomotic collagen was significantly higher in group II rats than in groups I and III rats. Thus, uncontrolled diabetes lowers anastomotic strength without affecting anastomotic collagen content. Defective repair is prevented by pancreatic islet transplantation before surgery.
Verhofstad
M H
MH
Department of Surgery, University Hospital Nijmegen, Nijmegen, The Netherlands.
van der Hem
L G
LG
van der Vliet
J A
JA
Hendriks
T
T