title: Effects of the ischemic preconditioning on anastomotic healing in laparoscopic colon operations.
abstract: BACKGROUND
  Previous experimental studies have repeatedly demonstrated the potential protective effect of remote ischemic preconditioning (IPC) on colon anastomosis. The purpose of this experimental study was to investigate the possible positive effects of IPC by interval insufflations in laparoscopic colon operations.
  
  
  METHODS
  Thirty Wistar-albino rats were randomized into 3 groups. Colonic transsection and anastomosis were performed in the control group. In the laparoscopic colon operation without IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 60 minutes, and then laparotomy and colonic anastomosis were performed. In the IPC group, the intra-abdominal pressure was raised to 14 mm Hg for 5 minutes, followed by desufflation. Laparotomy and colonic anastomosis were performed exactly as in the non-IPC group. On the seventh postoperative day, all animals were killed, and blood and tissue samples were obtained. Anastomotic healing and inflammatory responses were determined by histopathologic examination and by measuring the anastomotic bursting pressure, tissue hydroxyproline level, and tissue and serum nitric oxide, malondialdehyde (MDA), and catalase activity levels. Differences with P-values of <0.05 were considered to be statistically significant.
  
  
  RESULTS
  Although the best anastomotic healing was detected in the control group, anastomotic healing was better in the IPC group than that in the non-IPC group. In terms of anastomotic bursting pressure, plasma MDA, serum catalase activity, and tissue nitric oxide levels, the IPC group was superior to the non-IPC group. No significant differences were found between the control and IPC groups, except in the plasma MDA levels.
  
  
  CONCLUSIONS
  Use of IPC with colon anastomosis had positive effects on wound healing and may serve as a safe method to reduce the adverse effects of ischemia and wound healing in laparoscopic colon operations.
authors.affiliation: Department of General Surgery, Faculty of Medicine, Namik Kemal University, Tekirdag, Turkey.
authors.forename: Sibel O
authors.initials: SO
authors.lastname: Gurdal
authors.forename: Atilla
authors.initials: A
authors.lastname: Celik
authors.forename: Aysun S
authors.initials: AS
authors.lastname: Celik
authors.forename: Savas
authors.initials: S
authors.lastname: Guzel
authors.forename: Rafet
authors.initials: R
authors.lastname: Mete
authors.forename: Onder
authors.initials: O
authors.lastname: Sahin
authors.forename: Gursel R
authors.initials: GR
authors.lastname: Soybir
authors.forename: Coskun
authors.initials: C
authors.lastname: Polat
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D002374:Catalase / Q000378:metabolism; D003106:Colon / Q000601:surgery*; D007327:Insufflation / Q000379:methods; D019194:Ischemic Preconditioning / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D009569:Nitric Oxide / Q000378:metabolism; D011897:Random Allocation; D051381:Rats; D017208:Rats, Wistar; D014945:Wound Healing / Q000502:physiology*
chemical_list: D009569:Nitric Oxide; D008315:Malondialdehyde; D002374:Catalase