Brief Article
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World J Gastroenterol. Mar 14, 2011; 17(10): 1308-1316
Published online Mar 14, 2011. doi: 10.3748/wjg.v17.i10.1308
Impact of remote ischemic preconditioning on wound healing in small bowel anastomoses
Philipp Anton Holzner, Birte Kulemann, Simon Kuesters, Sylvia Timme, Jens Hoeppner, Ulrich Theodor Hopt, Goran Marjanovic
Philipp Anton Holzner, Birte Kulemann, Simon Kuesters, Jens Hoeppner, Ulrich Theodor Hopt, Goran Marjanovic, Surgical Metabolic and Anastomotic Research Team, Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg 79106, Germany
Sylvia Timme, Institute of Pathology, Albert Ludwigs University of Freiburg, Freiburg 79106, Germany
Author contributions: Holzner PA, Kulemann B, Kuesters S and Marjanovic G designed the research; Holzner PA and Marjanovic G performed the research; Timme S and colleagues performed the histological examination; Hoeppner J contributed new analytic tools; Holzner PA and Marjanovic G analyzed the data; Hopt UT and Marjanovic G reviewed the paper before submission; Holzner PA wrote the paper.
Supported by Science Fund of the Department for General and Visceral Surgery at the University of Freiburg
Correspondence to: Philipp Anton Holzner, MD, Department of General and Visceral Surgery, Albert Ludwigs University of Freiburg, Freiburg 79106, Germany. philipp.holzner@uniklinik-freiburg.de
Telephone: +49-761-2702806 Fax: +49-761-2702804
Received: September 2, 2010
Revised: November 17, 2010
Accepted: November 24, 2010
Published online: March 14, 2011
Abstract

AIM: To investigate the influence of remote ischemic preconditioning (RIPC) on anastomotic integrity.

METHODS: Sixty male Wistar rats were randomized to six groups. The control group (n = 10) had an end-to-end ileal anastomosis without RIPC. The preconditioned groups (n = 34) varied in time of ischemia and time of reperfusion. One group received the amino acid L-arginine before constructing the anastomosis (n = 9). On postoperative day 4, the rats were re-laparotomized, and bursting pressure, hydroxyproline concentration, intra-abdominal adhesions, and a histological score concerning the mucosal ischemic injury were collected. The data are given as median (range).

RESULTS: On postoperative day 4, median bursting pressure was 124 mmHg (60-146 mmHg) in the control group. The experimental groups did not show a statistically significant difference (P > 0.05). Regarding the hydroxyproline concentration, we did not find any significant variation in the experimental groups. We detected significantly less mucosal injury in the RIPC groups. Furthermore, we assessed more extensive intra-abdominal adhesions in the preconditioned groups than in the control group.

CONCLUSION: RIPC directly before performing small bowel anastomosis does not affect anastomotic stability in the early period, as seen in ischemic preconditioning.

Keywords: Anastomotic healing, Hydroxyproline, Bursting pressure, Mucosal injury index, Wound healing, Remote ischemic preconditioning