title: Influence of CD68+ macrophages and neutrophils on anastomotic healing following laparoscopic sigmoid resection due to diverticulitis.
abstract: BACKGROUND
  The aim of this prospective study was to evaluate the predictive value of a potential preexisting low-grade inflammation regarding the incidence of anastomotic leakage in elective laparoscopic sigmoid resection due to diverticulitis.
  
  
  METHODS
  Patients with either chronically recurrent diverticulitis or sigmoid stenosis caused by chronic diverticulitis were included in this study. All patients with acute local or systemic inflammation were excluded. Detailed patient information (e.g. American Society of Anesthesiologists (ASA) grade, comorbidities, duration of hospital stay, and anastomotic leakage) was prospectively recorded. CD68(+) macrophages, neutrophils, CD3(+) T-lymphocytes, CD11c(+) dendritic cells, MHCII, TNFR1, and NF-κB were evaluated by immunohistochemistry within the acquired sample of colonic bowel wall tissue. Clinical and immunohistochemical data was compared between groups (leakage vs. no leakage). Additionally, a matched-pair analysis was performed due to the widely heterogeneous groups concerning the number of patients and to minimize the effect of extraneous variables.
  
  
  RESULTS
  A total of 83 patients were included in the study, of which 7 patients suffered an anastomotic leakage. Neither the clinical nor the immunohistochemical parameters were significantly different between the groups. The matched-pair analysis revealed a nonsignificant increase in mean duration of hospital stay for the group with anastomotic leakage and a significantly higher percentage of CD68(+) macrophages and neutrophils in the colonic wall obtained at the index operation in both the mucosal and submucosal layers for the leakage group.
  
  
  CONCLUSIONS
  A preexisting low-grade inflammation represented by infiltrates of macrophages and neutrophils is a predictor for increased risk of developing colon anastomotic leakage.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074, Aachen, Germany, mbinneboesel@ukaachen.de.
authors.forename: Marcel
authors.initials: M
authors.lastname: Binnebösel
authors.forename: Tim
authors.initials: T
authors.lastname: Schuler
authors.forename: Christian D
authors.initials: CD
authors.lastname: Klink
authors.forename: Daniel
authors.initials: D
authors.lastname: Busch
authors.forename: Dominik S
authors.initials: DS
authors.lastname: Schöb
authors.forename: Klaus T
authors.initials: KT
authors.lastname: von Trotha
authors.forename: Ulf P
authors.initials: UP
authors.lastname: Neumann
authors.forename: Karsten
authors.initials: K
authors.lastname: Junge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000276:immunology*; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D002908:Chronic Disease; D003082:Colectomy; D012809:Colon, Sigmoid / Q000276:immunology / Q000601:surgery*; D004239:Diverticulitis, Colonic / Q000276:immunology / Q000601:surgery*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008264:Macrophages / Q000276:immunology*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology*; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D014945:Wound Healing / Q000276:immunology*; D055815:Young Adult; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; C067980:CD68 antigen, human; D000097382:CD68 Molecule
references.citation: Surgery. 2005 Feb;137(2):229-34
references.pmid: 15674206
references.citation: J Immunol. 2013 May 15;190(10):5226-36
references.pmid: 23596313
references.citation: Dan Med J. 2012 May;59(5):C4453
references.pmid: 22549495
references.citation: Dtsch Med Wochenschr. 2010 Sep;135(36):1743-8
references.pmid: 20812161
references.citation: Dis Colon Rectum. 2006 Nov;49(11):1719-25
references.pmid: 17051321
references.citation: Fibrogenesis Tissue Repair. 2012 Jun 06;5(Suppl 1):S27
references.pmid: 23259611
references.citation: Surg Endosc. 2013 Mar;27(3):864-71
references.pmid: 23052507
references.citation: J Gastrointest Surg. 2013 Sep;17(9):1698-707
references.pmid: 23690209
references.citation: PLoS One. 2012;7(6):e38917
references.pmid: 22701728
references.citation: Best Pract Res Clin Anaesthesiol. 2004 Sep;18(3):439-54
references.pmid: 15212338
references.citation: Surg Endosc. 2011 Apr;25(4):1121-6
references.pmid: 20872022
references.citation: JSLS. 2010 Oct-Dec;14(4):469-75
references.pmid: 21605507
references.citation: Mol Immunol. 2013 Dec;56(4):347-53
references.pmid: 23911389
references.citation: Nat Immunol. 2006 Jun;7(6):652-62
references.pmid: 16633346
references.citation: Hepatology. 2009 Jul;50(1):261-74
references.pmid: 19554540
references.citation: Gastroenterology. 2003 Jun;124(7):1809-20
references.pmid: 12806615
references.citation: Ann Surg. 2005 Oct;242(4):576-81; discussion 581-3
references.pmid: 16192818
references.citation: Am Surg. 1996 Jan;62(1):14-8
references.pmid: 8540639
references.citation: Zentralbl Chir. 2009 Jun;134(3):242-8
references.pmid: 19536719
references.citation: Colorectal Dis. 2009 Nov;11(9):917-20
references.pmid: 19175646
references.citation: J Exp Med. 2006 Mar 20;203(3):583-97
references.pmid: 16492803
references.citation: Ann Surg. 2009 Jan;249(1):39-44
references.pmid: 19106674
references.citation: Int J Colorectal Dis. 2009 May;24(5):569-76
references.pmid: 19221768
references.citation: Dis Colon Rectum. 2000 Mar;43(3):290-7
references.pmid: 10733108
references.citation: Langenbecks Arch Surg. 2004 Apr;389(2):97-103
references.pmid: 14985985
references.citation: Surg Endosc. 2013 Oct;27(10):3877-82
references.pmid: 23708715
references.citation: Colorectal Dis. 2012 Jun;14(6):671-83
references.pmid: 21689339
references.citation: J Gastrointest Surg. 2013 Nov;17(11):1966-71
references.pmid: 23918084
references.citation: World J Surg. 2008 Feb;32(2):296-304
references.pmid: 18066614
references.citation: Anticancer Res. 2010 Feb;30(2):601-7
references.pmid: 20332477
references.citation: Int J Colorectal Dis. 2002 Nov;17(6):420-5
references.pmid: 12355219
references.citation: Immunol Today. 1994 Feb;15(2):74-80
references.pmid: 7512342
references.citation: J Innate Immun. 2014;6(1):111-6
references.pmid: 23860188
references.citation: Int J Colorectal Dis. 2011 Jun;26(6):737-46
references.pmid: 21404056
references.citation: Arch Surg. 1991 Nov;126(11):1423-6
references.pmid: 1660707
references.citation: Surgery. 2010 Jul;148(1):59-70
references.pmid: 20153496
references.citation: J Am Coll Surg. 2010 Oct;211(4):485-9
references.pmid: 20822739
references.citation: Langenbecks Arch Surg. 2011 Mar;396(3):371-8
references.pmid: 21279822