Infliximab's influence on anastomotic strength and degree of inflammation in intestinal surgery in a rabbit model.
BACKGROUND
Infliximab, a TNF-α inhibitor, is a potent anti-inflammatory drug in the treatment of inflammatory bowel diseases. Recent studies have investigated the effect of infliximab treatment on postoperative complications such as anastomotic leakage, however, with conflicting results and conclusions. The purpose of this study was to investigate whether a single dose infliximab has an adverse effect on the anastomotic healing process, observed as reduced anastomotic breaking strength and histopathologically verified lower grade of inflammatory response, in the small intestine of a rabbit.


METHODS
Thirty New Zealand rabbits (median weight 2.5 kg) were allocated to treatment with an intravenous bolus of either 10 mg/kg infliximab (n = 15) or placebo (n = 15). One week later all rabbits underwent two separate end-to-end anastomoses in the jejunum under general anesthesia. At postoperative day three, the anastomotic breaking strength was determined and histopathological changes were examined.


RESULTS
The mean value of anastomotic breaking strength in the placebo group was 1.89 ± 0.36 N and the corresponding value was 1.81 ± 0.33 N in the infliximab treated rabbits. There was no statistically significant difference between the groups (p = 0.51). The infliximab-treated rabbits had a significant lower degree of inflammatory infiltration response compared to the placebo group (p = 0.047).


CONCLUSIONS
Our conclusion, limited by the small sample sizes in both groups, is that a single dose of infliximab, given one week prior to surgery, does not have an impact on the anastomotic breaking strength on the third postoperative day in the small intestine of rabbits.
Surgical Department A, Odense University Hospital, Sdr, Boulevard 29, 5000 Odense, C, Denmark. erik.frostberg@rsyd.dk.
Erik
E
Frostberg
Petter
P
Ström
Oke
O
Gerke
Niels
N
Qvist
D000714:Anastomosis, Surgical; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects*; D004334:Drug Administration Schedule; D005260:Female; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology*; D000069285:Infliximab; D007275:Injections, Intravenous; D007583:Jejunum / Q000187:drug effects / Q000601:surgery*; D011183:Postoperative Complications; D057234:Preoperative Period; D011817:Rabbits; D011897:Random Allocation; D013718:Tensile Strength / Q000187:drug effects*; D014945:Wound Healing / Q000187:drug effects*
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab