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Mekkawy AH, Breakeit M, Pillai K, Badar S, Akhter J, Valle SJ, Morris DL. Intraperitoneal BromAc ® Does Not Interfere with the Healing of Colon Anastomosis. Cancers (Basel) 2023; 15:3321. [PMID: 37444430 DOI: 10.3390/cancers15133321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/06/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
A combination of bromelain and acetylcysteine, BromAc®, is an efficient intraperitoneal mucolytic for thick mucus secreted in pseudomyxoma peritonei (PMP). Patients with PMP quite often undergo colon anastomosis. Hence, we investigated the effect of the intraperitoneal delivery of BromAc® on colon-anastomosis healing in a rat model. Sixteen Wistar rats were divided into two groups (N = 8). The controls received intraperitoneal saline after anastomosis, whilst the other group received BromAc®. They were monitored for body-weight and general health parameters. Half the rats in each group (N = 4) were culled at 4 or 13 days post-surgery for assessment. The healing process of the tissues was assessed by burst pressure and collagen density with histology to assess the integrity of the internal organs. The results indicated that there was a similar pattern of weight fluctuation during the experiment, although the rats treated with the BromAc® showed slightly greater weight loss during the first 4 days. Although the burst pressure was similar in both groups, the BromAc® group at day 13 showed a slightly higher burst pressure, which was complemented by a higher collagen density (albeit not statistically significant). The histology of the internal organs was comparable to those of the controls. This study indicates that the intraperitoneal delivery of BromAc® in a rat model does not interfere with the healing process of colonic anastomosis.
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Affiliation(s)
- Ahmed H Mekkawy
- Mucpharm Pty Ltd., Sydney, NSW 2217, Australia
- Department of Surgery, St George Hospital, Sydney, NSW 2217, Australia
- St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Mohammad Breakeit
- Mucpharm Pty Ltd., Sydney, NSW 2217, Australia
- Department of Surgery, St George Hospital, Sydney, NSW 2217, Australia
| | - Krishna Pillai
- Mucpharm Pty Ltd., Sydney, NSW 2217, Australia
- Department of Surgery, St George Hospital, Sydney, NSW 2217, Australia
| | - Samina Badar
- Department of Surgery, St George Hospital, Sydney, NSW 2217, Australia
- St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
| | - Javed Akhter
- Mucpharm Pty Ltd., Sydney, NSW 2217, Australia
- Department of Surgery, St George Hospital, Sydney, NSW 2217, Australia
| | - Sarah J Valle
- Mucpharm Pty Ltd., Sydney, NSW 2217, Australia
- Department of Surgery, St George Hospital, Sydney, NSW 2217, Australia
- Intensive Care Unit, St George Hospital, Sydney, NSW 2217, Australia
| | - David L Morris
- Mucpharm Pty Ltd., Sydney, NSW 2217, Australia
- Department of Surgery, St George Hospital, Sydney, NSW 2217, Australia
- St George & Sutherland Clinical School, University of New South Wales, Sydney, NSW 2217, Australia
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Braunwarth E, Ratti F, Aldrighetti L, Al-Saffar HA, D Souza MA, Sturesson C, Linke R, Schnitzbauer A, Bodingbauer M, Kaczirek K, Vagg D, Toogood G, Ferraro D, Fusai GK, Diaz-Nieto R, Malik H, Hoogwater FJH, Wagner D, Kornprat P, Fischer I, Függer R, Göbel G, Öfner D, Stättner S. Incidence and risk factors for anastomotic bile leakage in hepatic resection with bilioenteric reconstruction - A international multicenter study. HPB (Oxford) 2023; 25:54-62. [PMID: 36089466 DOI: 10.1016/j.hpb.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/03/2022] [Accepted: 08/19/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anastomotic leak (AL) after bilioenteric reconstruction (BR) is a feared complication after bile duct resection, especially in combination with liver resection. Literature on surgical outcome is sparse. This study aimed to determine the incidence and risk factors for AL after combined liver and bile duct resection with a focus on operative or endoscopic reinterventions. METHODS Data from consecutive patients who underwent liver resection and BR between 2004 and 2018 in 11 academic institutions in Europe were collected from prospectively maintained databases. RESULTS Within 921 patients, AL rate was 5.4% with a 30d mortality of 9.6%. Pringle maneuver (p<0.001),postoperative external biliary (p=0.007) and abdominal drainage (p<0.001) were risk factors for clinically relevant AL. Preoperative biliary drainage (p<0.001) was not associated with a higher rate of AL. AL was more frequent in stented patients (76.5%) compared to PTCD (17.6%) or PTCD+stent (5.9%,p=0.017). AL correlated with increased incidence of postoperative liver failure (p=0.036), cholangitis, hemorrhage and sepsis (all p<0.001). CONCLUSION This multicenter data provides the largest series to date of LR with BR and could help in the management of these patients which are often challenging and hampering the patients' postoperative course negatively.
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Affiliation(s)
- Eva Braunwarth
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Francesca Ratti
- Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Luca Aldrighetti
- Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Hasan A Al-Saffar
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Melroy A D Souza
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Sturesson
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Richard Linke
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General-, Visceral-, Transplant- and Thoracic Surgery, Frankfurt am Main, Germany
| | - Andreas Schnitzbauer
- University Hospital Frankfurt, Goethe-University Frankfurt/Main, Department of General-, Visceral-, Transplant- and Thoracic Surgery, Frankfurt am Main, Germany
| | - Martin Bodingbauer
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Kaczirek
- Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Vagg
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK; Faculty of Medicine and Health, The University of Sydney, Australia
| | - Giles Toogood
- Department of Hepatobiliary Surgery, St James's University Hospital, Leeds, UK
| | - Daniele Ferraro
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK; Department of Gastroenterology, AORN Antonio Cardarelli, Naples, Italy
| | - Giuseppe K Fusai
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK
| | | | | | - Frederik J H Hoogwater
- Department of Surgery, Section Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Doris Wagner
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Peter Kornprat
- Department of General Surgery, Medical University of Graz, Graz, Austria
| | - Ines Fischer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
| | | | - Georg Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Öfner
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Stättner
- Department of General, Visceral and Vascular Surgery, Salzkammergut Klinikum, Vöcklabruck, Austria.
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Almabayev Y, Salimgereeva B, Kamyspayev M, Yergazina M, Yermentayeva Z, Zhelderbayeva M, Dzhunusova R, Fakhradiyev I, Tanabayeva S. The Use of Newly Synthesized Composite Scaffolds for Bone Regeneration - A Review of Literature. Serbian Journal of Experimental and Clinical Research 2022; 0. [DOI: 10.2478/sjecr-2021-0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Abstract
At present, clamping of the portal triad is a widespread surgical procedure in hospitals. Such an operation can prevent pathological changes in the organs. However, the optimal time for clamping remains unclear. To determine the starting time of irreversible morphological changes in the small intestine due to the clamping of the portal triad. The study was carried out on rats (n=94). Animals were randomly subdivided into 4 groups based on the duration of clamping of the portal triad (PT): I control group (CG; without clamping the PT; n=10); II intervention group (6-IG; clamping PT for 6 min; n=28); III intervention group (12-IG; clamping time of the PT for 12 min; n=28); IV intervention group (24-IG; clamping time of the PT for 24 min; n=28). In groups 6- IG, 12-IG, 24-IG, after clamping the portal triad, animals were withdrawn from the experiment after 3 hours, 6 hours, 12 hours, 1 day, 3 days and 7 days. Morphological changes in the small intestine were assessed by measuring the diameter of the lumen of micro-vessels. In addition, the mortality in the groups was analysed as well. In the CG group, the diameter of the arterioles of the small intestine was 34±4 μm, the diameters of pre-capillaries were 15±2μm, the capillaries were 5.4±1 μm, the post-capillaries were 18±2 μm, and the diameter of the lumen of the venues was 40±3 μm. In the 6-IG group (on the 3rd day), the structure of the small intestine showed the recovery signs. By the 7th day, the indicators returned to their original values. In the 12-IG group, the parameters of the small intestine were restored on the seventh day that corresponds to the usual course of the disease. However, in the 24-IG group, changes in these organs persisted until the end of the study. No deaths were reported in the CG and 6-IG animal groups. Mortality among rats of the 12-IG group was 14.3%, while in the 24-IG group with PT clamping for 24 minutes it was 42.8%, respectively. The morphological changes in the microvasculature of the small intestine after 6-minute PT clamping showed a tendency to recover (back to the control parameters). Nevertheless, after 24 minutes of clamping, the changes in the intestinal tissue were irreversible.
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Chen Q, Zhang R, Xing B, Li C, Xiu D, Chen J, Deng Y, Chen X, Guo R, Chen F, Peng J, Sun T, Wang H, Li M, Zheng Q, Bi X, Zhao J, Zhou J, Li Z, Huang Z, Zhang Y, Zhang Y, Cai J, Zhao H. Optimal surgical sequence for colorectal cancer liver metastases patients receiving colorectal cancer resection with simultaneous liver metastasis resection: A multicentre retrospective propensity score matching study. Int J Surg 2022; 106:106952. [DOI: 10.1016/j.ijsu.2022.106952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/14/2022] [Accepted: 10/03/2022] [Indexed: 11/09/2022]
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Liu J, Wang W, Shi C, Li C, Xue F, Hu L, Wang Y, Ge R. The difference in prolonged continuous and intermittent Pringle maneuver during complex hepatectomy for hepatocellular carcinoma patients with chronic liver disease: A retrospective cohort study. Cancer Med 2021; 10:8507-8517. [PMID: 34658153 PMCID: PMC8633214 DOI: 10.1002/cam4.4361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/07/2021] [Accepted: 09/23/2021] [Indexed: 01/20/2023] Open
Abstract
Purpose To explore the differences between prolonged continuous Pringle maneuver (CPM) and prolonged intermittent Pringle maneuver (IPM) in patients with hepatocellular carcinoma (HCC), who underwent complex hepatectomy. Methods This retrospective cohort study performed between June 2014 and May 2016 included 142 patients who underwent complex hepatectomy for HCC and concomitant chronic liver disease but with good liver function. Patients were categorized into CPM (n = 69) and IPM groups (n = 73). The differences in these aspects were compared between the two groups which include operation time, intraoperative bleeding, perioperative transfusion, postoperative complications, liver function injury, postoperative overall survival (OS), and tumor recurrence. Results The cumulative clamping time, operation time, intraoperative bleeding, and perioperative transfusion rates were 38.0, 132 min, 300 ml, and 17.4% in CPM and 40.0, 145 min, 400 ml, and 32.9% in IPM, respectively. There were significant intergroup differences in operation time (p = 0.018), intraoperative bleeding (p < 0.001), and perioperative transfusion rates (p = 0.034). Besides, the postoperative complications and postoperative liver function injury of the CPM group were better than those of IPM. There was no significant intergroup difference in OS (p = 0.908) and tumor recurrence (p = 0.671) between two groups. Conclusion Compared with IPM, CPM with a cumulative clamping time between 30 and 50 min can shorten operation time, reduce intraoperative bleeding and perioperative transfusion, and reduce postoperative complications and postoperative liver function injury in patients who underwent complex hepatectomy for HCC and concomitant liver disease but with good liver function. There was no significant difference in OS and tumor recurrence between two groups.
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Affiliation(s)
- Jianwei Liu
- Department of Hepatic Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wei Wang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Chunchao Shi
- Department of Hepatic Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Chenqi Li
- Department of Nutrition, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Feng Xue
- Department of Hepatic Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Lei Hu
- Department of Hepatic Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Yi Wang
- Department of Hepatic Surgery II, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Ruiliang Ge
- Department of Outpatient, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
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Lin N, Li J, Ke Q, Wang L, Liu J. Does intermittent pringle maneuver loss its clinical value in reducing bleeding during hepatectomy? A systematic review and meta-analysis. Int J Surg 2020; 81:158-164. [DOI: 10.1016/j.ijsu.2020.06.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 02/08/2023]
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Alvarenga Junior V, Ferraz ED, Rolim M, Carra AM, Silva PTD, Franco OB, Cordeiro MMD, Takiya CM, Baetas-da-Cruz W, Manso JEF, Ferreira ML, Eulálio JMR, Silva PC, Souza HSPD, Schanaider A. Rat models of high risk colorectal anastomoses 1. Acta Cir Bras 2018; 33:914-923. [PMID: 30484501 DOI: 10.1590/s0102-865020180100000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/26/2018] [Indexed: 01/29/2023] Open
Abstract
PURPOSE To evaluate the most frequent surgical techniques of high-risk colorectal anastomoses in rats. METHODS Wistar rats were enrolled in three different models comprising inflammatory (TNBS enema), vascular (portal vein occlusion) or obstructive (a non-ischemic constricting ring) mechanisms associated with colonic anastomosis that had accomplished after these former lesions. Histological analyses (Hematoxylin and eosin and Picrosirius red) were performed. RESULTS All anastomoses techniques were associated with risk factors and had complications, mainly anastomotic leakage. In Study 1, the use of a pharmacological agent, trinitrobenzene sulfonic acid (TNBS) mimicked an inflammatory bowel disease such as Crohn's disease with 50% of anastomosis leakage, the higher percentage among all models tested. In Study 2, after portal ischemia followed by reperfusion it was observed a dense neutrophil infiltrate in the midst of necrotic tissue and fibrin at the anastomotic site and 5 days after the anastomosis, no collagen was produced. In Study 3, 5 days after the mechanical obstruction some denuded areas of epithelium with marked oedema of mucosa and submucosa were seen, at the anastomotic site and anastomosis group showed some reduction of collagen density when compared with Control/Sham group. CONCLUSION All the experimental surgical techniques tested in rats were associated with high-risk colorectal anastomoses and were useful to study colonic anastomotic healing and intestinal leakage.
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Affiliation(s)
- Valter Alvarenga Junior
- Fellow PhD degree, Postgraduate Program in Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Brazil. Acquisition, analysis and interpretation of data; technical procedures
| | - Edna Delabio Ferraz
- Fellow PhD degree, Postgraduate Program in Surgical Sciences, Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Brazil. Acquisition, analysis and interpretation of data; technical procedures
| | - Marcia Rolim
- Fellow Master degree, Postgraduate Program in Surgical Sciences, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Acquisition, analysis and interpretation of data; technical procedures
| | - Amabile Marran Carra
- Graduate student, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Technical procedures
| | - Pedro Teixeira da Silva
- Graduate student, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Technical procedures
| | - Olavo Borges Franco
- Graduate student, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Technical procedures
| | | | - Christina Maeda Takiya
- Associate Professor, Postgraduate Program in Surgical Sciences, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Analysis and interpretation of data, critical revision
| | - Wagner Baetas-da-Cruz
- Graduate student, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Technical procedures
| | - José Eduardo Ferreira Manso
- Associate Professor, Postgraduate Program in Surgical Sciences, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Analysis and interpretation of data, critical revision
| | - Manoel Luiz Ferreira
- PhD, Associate Professor, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Analysis and interpretation of data, technical procedures
| | - José Marcus Raso Eulálio
- PhD, Associate Professor, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Analysis and interpretation of data, technical procedures
| | - Paulo César Silva
- PhD, Associate Professor, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Analysis and interpretation of data, technical procedures
| | - Heitor Siffert Pereira de Souza
- PhD, Full Professor, Experimental Surgical, Coordinator of Postgraduate Program in Medical Clinics, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Intellectual, conception and design of the study; analysis and interpretation of data
| | - Alberto Schanaider
- PhD, Full Professor, Head, Centre of Experimental Surgical, Coordinator of Postgraduate Program in Surgical Science, Department of Surgery, School of Medicine, UFRJ, Rio de Janeiro-RJ, Brazil. Intellectual, conception and design of the study; analysis and interpretation of data; manuscript preparation; critical revision
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Abstract
Background: Bipolar sealing devices are routinely used to seal blood vessels. The aim of the study is to evaluate the feasibility and safety of colonic sealing with the use of the bipolar energy devices in rats as model for experimental appendectomy. Methods: Seventy-five male Wistar rats underwent a cecal resection with four different bipolar sealing devices or a linear stapler. The harvesting procedure was performed immediately or at postoperative day (POD) 7. The sealing front bursting pressure (BP) was measured in both groups. At POD7, the resection line was clinically examined and the hydroxyproline (HDP) levels were determined. Hematoxylin and Eosin (H&E) staining was used for histopathological evaluation of the sealing front as well. Results: There was no mortality and no insufficiency. The BPs between the bipolar sealing devices showed no statistical differences. The early phase of the seal (POD 0) provides a low BP with an 30.8% increase until POD 7. The BPs in the stapler group showed significant better values. The hydroxyproline levels did not differ statistically between the groups. Histopathologically, there were more signs of ischemic necrosis in the stapler group than in the sealing devices groups. Conclusion: The resection and sealing of the cecum as an experimental appendectomy model with the use of bipolar energy devices proved feasible and safe in rats. The different energy devices in this study produce comparable results. To justify clinical practice in humans, several studies on the underlying mechanisms of early stage wound healing are needed.
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Affiliation(s)
- E Tagkalos
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - A Heimann
- Institute for Neurosurgical Pathophysiology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - T Gaiser
- Department of Pathology, University Hospital Mannheim, Mannheim, Germany
| | - D Hirsch
- Department of Pathology, University Hospital Mannheim, Mannheim, Germany
| | - I Gockel
- Department of Visceral, Transplant-, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - B Jansen-Winkeln
- Department of Visceral, Transplant-, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
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