title: Infliximab treatment reduces tensile strength in intestinal anastomosis.
abstract: BACKGROUND
  The antitumor necrosis factor (infliximab [IFX]) has gained widespread use in the treatment of inflammatory bowel disease. However, several patients must undergo surgical treatment due to treatment failure and there is a potential risk that preoperative IFX treatment may have a negative effect on the healing process in intestinal anastomosis. The objective of this study was to examine the effect of repeated IFX treatment on anastomotic strength and degree of inflammation in the anastomotic line in the small intestine of rabbits.
  
  
  METHODS
  Thirty-two rabbits were randomized (2:1) to receive either repeated IFX treatment or placebo. On day 15, three separate end-to-end anastomoses were performed on the jejunum. On postoperative day 5, tensile strength and bursting pressure for the anastomoses were tested and histologic changes examined.
  
  
  RESULTS
  We found a significantly reduced tensile strength in the IFX group (1.94 ± 0.44 N) compared with the placebo group (3.33 ± 0.39 N), (P < 0.001). Calculation of Spearman correlation coefficients showed a positive significant correlation between minimal tensile strength and serum values of IFX (coefficient = -0.63; P = 0.003) as well as number of sutures in the tested anastomosis (coefficient = 0.51; P = 0.024). The general histologic score was significantly higher in the placebo group (5.00 ± 1.26 versus 3.31 ± 1.65, P = 0.03).
  
  
  CONCLUSIONS
  Repeated high-dose IFX treatment reduces tensile strength significantly in rabbits and should be investigated further as a potential risk factor of anastomotic dehiscence in inflammatory bowel disease surgery.
authors.affiliation: Department of Surgery, Kolding Hospital, Kolding, Denmark. Electronic address: jsanberg@dadlnet.dk.
authors.forename: Jonas Sanberg
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
authors.forename: Nacie Bello
authors.initials: NB
authors.lastname: Petersen
authors.affiliation: Department of Pathology, Odense University Hospital, Odense, Denmark.
authors.forename: Matteo
authors.initials: M
authors.lastname: Biagini
authors.affiliation: Biomedical Laboratory, Faculty of Health Science, University of Southern Denmark, Odense Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Bollen
authors.affiliation: Department of Surgery A, Odense University Hospital, Odense, Denmark. Electronic address: famqvist@dadlnet.dk.
authors.forename: Niels
authors.initials: N
authors.lastname: Qvist
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000494:pharmacology*; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D004751:Enteritis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005260:Female; D000069285:Infliximab; D007421:Intestine, Small / Q000187:drug effects / Q000502:physiology / Q000601:surgery; D010919:Placebos; D011817:Rabbits; D011897:Random Allocation; D018570:Risk Assessment; D013529:Surgical Wound Dehiscence / Q000209:etiology* / Q000503:physiopathology; D013537:Sutures; D013718:Tensile Strength / Q000187:drug effects* / Q000502:physiology; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D000911:Antibodies, Monoclonal; D010919:Placebos; D000069285:Infliximab
keywords: Gastrointestinal healing; Infliximab; Intestinal anastomosis