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International Journal of Colorectal Disease
Published in: International Journal of Colorectal Disease 8/2015

01-08-2015 | Original Article

Circular anastomotic experimental fibrin sealant protection in deep colorectal anastomosis in pigs in a randomized 9-day survival study

Authors: F. A. Wenger, E. Szucsik, B. F. Hoinoiu, A. M. Cimpean, M. Ionac, M. Raica

Published in: International Journal of Colorectal Disease | Issue 8/2015

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Abstract

Purpose

The reported rate of clinically apparent anastomotic leakage (AL) in a low anterior resection of the rectum (LAR) (≤7 cm from the anal verge) using a circular double-stapled anastomosis (CDSA) without defunctioning stoma is up to 37.5 %. Since AL may result in life-threatening peritonitis, sepsis, and multiple organ failure, LAR and CDSA are regularly combined with defunctioning stoma. Accordingly, we now evaluated whether LAR and CDSA without defunctioning stoma but with extraluminal anastomotic application of an experimental fibrin sealant reduce the AL rate. This might prevent humans from defunctioning stoma increasing quality of life and decreasing surgical costs.

Methods

Forty 8-week-old pigs underwent LAR and CDSA in an end-to-end technique (descendo-rectostomy). Animals were randomized into a therapy and control group (gr.). The therapy gr. (n = 20) received an additional extraluminal circular application of an experimental fibrin sealant to the anastomosis. The objective was to assess the incidence of clinically apparent and non-clinically apparent leakage through the ninth postoperative day. Double-contrast barium CT radiographs of the colorectal region were performed on the ninth postoperative day or earlier, in case there were clinical signs of AL. All remaining animals were sacrificed on the ninth postoperative day and the anastomotic region was histopathologically analyzed. In case of earlier diagnosed AL, animals were sacrificed immediately. Blood samples were taken for complete blood count, chemistry, and coagulation profile prior to surgery and on the first, third, fifth, seventh, and ninth postoperative day.

Results

A circular extraluminal anastomotic application of an experimental fibrin protection decreased the rate of clinically and non-clinically apparent AL from 20 % (n = 4) in the control group to 5 % (n = 1) in the treatment group. Ulcerations were also observed in both gr. (control gr.—5 animals, therapy gr. —3 animals). All animals with AL showed necrosis surrounding the hole at the anastomoses. Three additional animals had a full wall defect at the anastomotic region that was blocked by the experimental fibrin sealant. The fibrin sealant was present at necropsy in all treated animals.

Conclusion

Circular anastomotic protection with the experimental fibrin sealant blocked anastomotic full wall defects, preventing peritonitis and significantly reducing the AL rate from 25 to 5 %.
Literature
1.
Peeters KC, Tollenaar RA, Marijnen CA, Klein-Kranenbarg E, Steup WH, Wiggers T, Rutten HJ, van de Veide CJ (2005) Risk factors for anastomotic failure after total mesorectal excision of rectal cancer. Br J Surg 92(6):211–216PubMedCrossRef
2.
Gastinger I, Marusch F, Steinert R, Wolff S, Koeckerling F, Lippert H (2005) Protective defunctioning stoma in low anterior resection for rectal carcinoma. Br J Surg 92(12):1565–1566
3.
Schmidt O, Merkel S, Hohenberger W (2003) Anastomotic leakage after low rectal stapler anastomosis: significance of intraoperative anastomotic testing. Eur J Surg Oncol 29(3):239–243PubMedCrossRef
4.
Sultan R, Chawla T, Zaidi M (2014) Factors affecting anastomotic leak after colorectal anastomosis in patients without protective stoma in tertiary care hospital. J Pak Med Assoc 64(2):166–170PubMed
5.
Cong ZJ HULH, Bian ZQ, Ye GY, Yu MH, Gao YH, Li ZS, Yu ED, Zhong M (2013) Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One 8(9):e75519PubMedCentralPubMedCrossRef
6.
van Erning FN, van Steenbergen LN, van den Broek WT, Rutten HJ, Lemmens VE (2013) No difference between lowest and highest volume hospitals in outcome after colorectal cancer surgery in the southern Netherlands. Eur J Surg Oncol 39(11):1199–1206PubMedCrossRef
7.
Dauser B, Braunschmid T, Ghffari S, Riss S, Stift A, Herbst F (2013) Anastomotic leakage after low anterior resection for rectal cancer: comparison of stapled versus compression anastomosis. Langenbecks Arch Surg 398(7):957–964PubMedCrossRef
8.
Ulrich AB, Seiler C, Rahbari N, Weitz J, Büchler MW (2009) Diverting stoma after low anterior resection: more arguments in favor. Dis Colon Rectum 52(3):412–418PubMedCrossRef
9.
Faflampas P, Christodoulakis M, Tsiftsis DD (2009) Anastomotic leakage after low anterior resection for rectal cancer: facts, obscurity and fiction. Surg Today 39(3):183–188CrossRef
10.
Marra F, Steffen T, Kalak N, Warschkow R, Tarantio I, Lange J, Zünd M (2009) Anastomotic leakage as a risk factor for the long-term outcome after curative resection of colon cancer. Eur J Surg Oncol 35(10):1060–1064PubMedCrossRef
11.
Zhi-Jie C, Liang-Hao H, Zheng-Qian B, Guang Y, Min-Hao Y, Yun-He G, Zhao-Shen L, En-DA Y, Min Z (2013) Systematic review of anastomotic leakage rate according to an international grading system following anterior resection for rectal cancer. PLoS One 8:1–11
12.
Wenger FA, Szucsik E, Hoinoiu BF, Ionac M, Walz MK, Schmid KW, Reis H (2013) A new anastomotic leakage model in circular double stapled colorectal anastomosis after low anterior rectum resection in pigs. J Invest Surg 26(6):364–372PubMedCrossRef
13.
Cong ZJ, Fu CG, Wang HT, Liu LJ, Zhang W, Wang H (2009) Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World J Surg 33(6):1292–1297PubMedCrossRef
14.
Matthiessen P, Hallböök O, Rutegard J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246(2):207–214PubMedCentralPubMedCrossRef
15.
Matthiessen P, Hallböök O, Andersson M, Rutegard J, Sjödahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6(6):462–469PubMedCrossRef
16.
Kim JS, Cho SY, Min BS, Kim NK (2009) Risk factors for anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapler technique. J Am Coll Surg 209(6):694–701PubMedCrossRef
17.
Taflampas P, Christodoulakis M, Tsiftsis DD (2009) Anastomotic leakage after low anterior resection for rectal cancer: facts, obscurity and fiction. Surg Today 39(3):183–188PubMedCrossRef
18.
Nordentoft T, Sorensen M (2007) Leakage of colon anastomoses: development of an experimental model in pigs. Eur Surg Res 39(1):14–16PubMedCrossRef
19.
Hoeppner J, Cmogorac V, Hopt UT, Weiser HF (2009) The pig as an experimental model for colonic healing study of leakage and ischemia in colonic anastomosis. J Invest Surg 22(4):281–285PubMedCrossRef
20.
Graffner H, Löwenhielm P, Walther B (1984) The healing process in high and low anterior resection of the rectum. A comparative study in the pig using stapling devices. Dis Colon Rectum 27(12):772–774PubMedCrossRef
21.
Krarup PM, Eld M, Heinemeier K, Jorgensen LN, Hansen MB, Agren MS (2013) Expression and inhibition of matrix metalloproteinase (MMP)-8, MMP-9 and MMP-12 in early colonic anastomotic repair. Int J Colorectal Dis 28(8):1151–1159PubMedCrossRef
22.
Syk I, Agren MS, Adawi D, Jeppsson B (2001) Inhibition of matrix metalloproteinases enhances breaking strength of colonic anastomoses in an experimental model. Br J Surg 88:228–234PubMedCrossRef
23.
De Hingh IH, de Man BM, Lomme RM, van Goor H, Hendriks T (2003) Colonic anastomotic strength and matrix metalloproteinase activity in an experimental model of bacterial peritonitis. Br J Surg 90:981–988PubMedCrossRef
24.
Martens MF, Hendriks T (1991) Postoperative changes in collagen synthesis in intestinal anastomoses of the rat: differences between small and large bowel. Gut 32:1482–1487PubMedCentralPubMedCrossRef
25.
Hesp FL, Hendriks T, Lubbers EJ, de Boer HH (1984) Wound healing in the intestinal wall. A comparison between experimental ileal and colonic anastomoses. Dis Colon Rectum 27:99–104PubMedCrossRef
26.
Khoury GA, Waxman BP (1983) Large bowel anastomoses. The healing process and sutured anastomoses. A review. Br J Surg 70:61–63PubMedCrossRef
27.
Bisset IP (2007) Ileocolic anastomotisis. Br J Surg 94:1147–1448
28.
Komen N, Van der Wal HC, Ditzel M, Kleinrensink GJ, Jeekel H, Lange JF (2009) Colorectal anastomotic leakage: a new experimental model. J Surg Res 155(1):7–12PubMedCrossRef
29.
Flodeen H, Hallböök O, Rutegard J, Sjödahl R, Matthiessen P (2012) Early and late anastomotic leakage following low anterior resection of the rectum for cancer: are they different entities? Colorectal Dis 15:334–340CrossRef
30.
Matthiesen P, Lindgren R, Hallböök O, Rutegard J, Sjödahl R (2010) Rectal Cancer Trial on Defunctioning Stoma Study Group. Symptomatic anastomosis leakage diagnosed after hospital discharge following low anterior resection for rectal cancer. Colorectal Dis 12:82–87CrossRef
31.
Morks AN, Ploeg RJ, Sijbrand Hofker H, Wiggers T, Havenga K (2013) Late anastomotic leakage in colorectal surgery: a significant problem. Colorectal Dis 15(5):271–275CrossRef
Metadata
Title
Circular anastomotic experimental fibrin sealant protection in deep colorectal anastomosis in pigs in a randomized 9-day survival study
Authors
F. A. Wenger
E. Szucsik
B. F. Hoinoiu
A. M. Cimpean
M. Ionac
M. Raica
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Colorectal Disease / Issue 8/2015
Print ISSN: 0179-1958
Electronic ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-015-2260-4

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