Ischemic preconditioning improves stability of intestinal anastomoses in rats.
BACKGROUND
The aim of our study was to establish whether ischemic preconditioning (IPC) directly before performing a small bowel anastomosis has an effect on anastomotic stability and healing.


METHODS
Forty male Wistar rats were randomized to five groups: control (CO, n = 8) with preparation of the superior mesenteric artery (SMA) but without IPC. IPC groups had different intervals of ischemia (occlusion of the SMA) and reperfusion: 10 min ischemia and 20 min reperfusion (IPC10/20, n = 7), 10 min ischemia and 30 min reperfusion (IPC10/30, n = 8), 15 min ischemia and 20 min reperfusion (IPC15/20, n = 8), and 15 min ischemia and 30 min reperfusion (IPC15/30, n = 9). On the fourth postoperative day, the animals were relaparotomized: bursting pressure, hydroxyproline concentration, and histological ischemia mucosal injury scale of the anastomosis were assessed.


RESULTS
Four days after operation, the mean bursting pressure was 73 +/- 6 mmHg in the control group, whereas it was significantly higher in IPC10/20 (113 +/- 11 mmHg; p = 0.018), IPC10/30 (110 +/- 13 mmHg; p = 0.001), and IPC15/30 (124 +/- 9 mmHg; p = 0.003). IPC15/20 did not show a significant difference (63 +/- 2 mmHg; p = 0.4). We did not find a significant effect regarding hydroxyproline concentration, but IPC diminished mucosal injury.


CONCLUSIONS
IPC directly before performing a small bowel anastomosis has a time-dependent beneficial effect on anastomotic stability, thus indicating a new clinical approach to improve the healing process of intestinal anastomosis.
Marjanovic
Goran
G
Department of General and Digestive Surgery, University of Freiburg, Freiburg im Breisgau, Germany. goran.marjanovic@uniklinik-freiburg.de
Jüttner
Eva
E
zur Hausen
Axel
A
Theodor Hopt
Ulrich
U
Obermaier
Robert
R
D000714:Anastomosis, Surgical; D000818:Animals; D003250:Constriction; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D006909:Hydroxyproline / Q000378:metabolism; D007082:Ileum / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D019194:Ischemic Preconditioning; D008297:Male; D017538:Mesenteric Artery, Superior / Q000601:surgery; D011312:Pressure; D051381:Rats; D017208:Rats, Wistar; D015427:Reperfusion Injury / Q000209:etiology / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*; D013536:Suture Techniques; D014945:Wound Healing
D006909:Hydroxyproline