title: Increased collagen maturity with sildenafil citrate: experimental high risk colonic anastomosis model.
abstract: BACKGROUND
  Inadequate healing and high anastomosis leak rates at rectal anastomosis may be due to lack of supportive serosal layer and technical difficulty of low anterior resections. Positive effects of sildenafil on wound healing were observed. The aim of this study was to simulate rectal anastomosis as a technical insufficient anastomosis and investigate the effects of sildenafil on anastomosis healing.
  
  
  METHODS
  Colonic anastomoses were carried out in 64 rats and randomized into four groups, CA-S, complete anastomoses without sildenafil (10 mg/kg for 5 days); CA+S, complete anastomoses with sildenafil; IA-S, incomplete anastomoses without sildenafil; IA+S, incomplete anastomoses with sildenafil. Half of the rats in every group were sacrificed on post-operative day (POD) 3, half of them sacrificed on POD 7. Tissues from the anastomoses were used for functional, histochemical, biochemical investigations.
  
  
  RESULTS
  Sildenafil treatment resulted in increased bursting pressures in IA+S on POD 7 (p=0.010). Collagen maturity was higher in IA+S on POD 3 and POD 7, CA+S on POD 7 (p=0.010; p=0.010; p<0.007). Collagen content was higher in IA+S on POD 7 (p<0.001). Glutathione, hydroxyproline levels were similar. Malondialdehyde levels were lower in IA+S on POD 3 (p<0.001). Epithelization score was higher in IA+S on POD 7 (p=0.007). Inflammation score was higher in CA-S group on POD 3 and POD 7 (p<0.001; p<0.001). Neutrophil score was lower in CA+S on POD 3 (p=0.005).
  
  
  CONCLUSIONS
  An increase in collagen content, maturity, and epithelization, a decrease in neutrophil infiltration, oxidative stress and better mechanical strength were observed with the administration of sildenafil.
authors.affiliation: Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Hacettepe Mah, 06230 Ankara, Turkey. Electronic address: cakir.tebessum@gmail.com.
authors.forename: Tebessum
authors.initials: T
authors.lastname: Cakir
authors.affiliation: Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Hacettepe Mah, 06230 Ankara, Turkey.
authors.forename: Ilter
authors.initials: I
authors.lastname: Ozer
authors.affiliation: Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Hacettepe Mah, 06230 Ankara, Turkey.
authors.forename: Erdal Birol
authors.initials: EB
authors.lastname: Bostanci
authors.affiliation: Department of Pathology, Turkiye Yuksek Ihtisas Training and Research Hospital, Hacettepe Mah, 06230 Ankara, Turkey.
authors.forename: Tulay Timucin
authors.initials: TT
authors.lastname: Keklik
authors.affiliation: Department of Biochemistry, Bilecik Public Hospital, Ertuğrulgazi Mah, 11040 Bilecik, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Ercin
authors.affiliation: Department of Biochemistry, Gazi University School of Medicine, Emniyet Mah, 06560 Ankara, Turkey.
authors.forename: Ayse
authors.initials: A
authors.lastname: Bilgihan
authors.affiliation: Department of Gastroenterological Surgery, Turkiye Yuksek Ihtisas Training and Research Hospital, Hacettepe Mah, 06230 Ankara, Turkey.
authors.forename: Musa
authors.initials: M
authors.lastname: Akoglu
mesh_terms: D000714:Anastomosis, Surgical; D057868:Anastomotic Leak / Q000517:prevention & control*; D000818:Animals; D003094:Collagen; D003106:Colon / Q000601:surgery*; D006909:Hydroxyproline; D008297:Male; D018384:Oxidative Stress; D010879:Piperazines / Q000627:therapeutic use*; D011687:Purines / Q000627:therapeutic use; D051381:Rats; D017208:Rats, Wistar; D000068677:Sildenafil Citrate; D013449:Sulfonamides / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D010879:Piperazines; D011687:Purines; D013449:Sulfonamides; D014665:Vasodilator Agents; D003094:Collagen; D000068677:Sildenafil Citrate; D006909:Hydroxyproline
keywords: Anastomosis leak; Anastomosis with technical deficiency; Collagen maturity; Colonic anastomosis healing; High risk anastomosis; Sildenafil citrate