title: Evaluating the effect of infliximab on the healing of left colonic anastomosis in the presence of intra-abdominal sepsis.
abstract: OBJECTIVE
  Infliximab (IFX) is a chimeric anti-TNF-α body which is effectively used in the treatment of inflammatory bowel diseases and a variety of autoimmune diseases. The effect of IFX on the healing of intestinal anastomosis has been evaluated in several studies, however with conflicting results. Furthermore, the effect of IFX on colonic anastomosis in sepsis has not been evaluated to date. In this study, we aimed to investigate whether IFX has an adverse effect on the healing process of colonic anastomosis either under normal or septic condition.
  
  
  METHODS
  The efficiency of IFX was assessed with respect to anastomotic bursting pressure (ABP), tissue hydroxyproline levels (THL) and histopathological examination of left colonic anastomosis in 40 male rats. The rats were randomly allocated into four groups of 10 rats each as control (C), septic control (SC), control IFX (C-IFX) and septic IFX (S-IFX).
  
  
  RESULTS
  The anastomotic bursting pressure was measured at 182±19.1, 158±15.4, 161±26.8 and 100±10.3mm/Hg, in C, SC, C-IFX and S-IFX; respectively. IFX administration did not influence the anastomotic strength under normal condition whereas in sepsis significantly induced the reduction of APB. The mean THL was almost similar in both control groups (p=0.87), whilst IFX reduced the level of TH in sepsis comparing with control groups (p=0.01). IFX significantly impaired immune response in sepsis resulting in poor anastomotic healing in S-IFX group.
  
  
  CONCLUSIONS
  Our study demonstrated that IFX had no detrimental effect on the healing of colonic anastomosis under normal condition whilst significantly impaired the healing process in sepsis.
authors.affiliation: Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey. Electronic address: dralpers@hotmail.com.
authors.forename: Alper
authors.initials: A
authors.lastname: Sozutek
authors.affiliation: Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey.
authors.forename: Sefa
authors.initials: S
authors.lastname: Ozyazici
authors.affiliation: Mersin University Medical Faculty, Department of General Surgery, Mersin, Turkey.
authors.forename: Tahsin
authors.initials: T
authors.lastname: Colak
authors.affiliation: Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Cetınkunar
authors.affiliation: Adana Numune Training and Research Hospital, Division of Gastroenterological Surgery, Department of General Surgery, Adana, Turkey.
authors.forename: Oktay
authors.initials: O
authors.lastname: Irkorucu
authors.affiliation: Mersin University Medical Faculty, Department of Biochemistry, Mersin, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Bobusoglu
authors.affiliation: Adana Numune Training and Research Hospital, Department of Pathology, Adana, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Cennet
mesh_terms: D056704:Adaptive Immunity / Q000187:drug effects*; D000714:Anastomosis, Surgical / Q000009:adverse effects; D000818:Animals; D003106:Colon / Q000473:pathology / Q000601:surgery*; D005765:Gastrointestinal Agents / Q000494:pharmacology*; D006909:Hydroxyproline / Q000378:metabolism; D000069285:Infliximab / Q000494:pharmacology*; D008297:Male; D011312:Pressure / Q000009:adverse effects; D051381:Rats; D012421:Rupture / Q000209:etiology; D018805:Sepsis / Q000150:complications / Q000503:physiopathology*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D005765:Gastrointestinal Agents; D000069285:Infliximab; D006909:Hydroxyproline
keywords: Anti-TNF therapy; Colonic anastomosis; Inflammatory bowel disease; Infliximab; Sepsis