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Effects of a Glutamine Enema on Anastomotic Healing in an Animal Colon Anastomosis Model
Mani Habibi, Osman Zekai Oner, Mehmet Tahir Oruc, Nurullah Bulbuller, Sebahat Ozdem, Sukru Ozdemir, Arsenal Sezgin Alikanooglu, Rojbin Karakoyun, Ugur Dogan, Ayper Ongen, Umit Koc
Ann Coloproctol. 2015;31(6):213-221.   Published online December 31, 2015
DOI: https://doi.org/10.3393/ac.2015.31.6.213
  • 14,057 View
  • 52 Download
  • 4 Web of Science
  • 4 Citations
AbstractAbstract PDF
Purpose

Anastomotic leakage in colorectal surgery is a very important issue. Although many studies have shown the positive effects of enteral glutamine (Gln) on anastomotic healing, none has assessed the effects of administering Gln via an enema for anastomotic healing. To fill this study gap, this study investigated the intraluminal effect of administration of Gln enema on the healing of colonic anastomosis in a rat model.

Methods

Thirty Wistar albino rats were divided into three groups containing 10 rats each and were subjected to distal left colon transection and anastomosis. Postoperatively, group I (the control group) was administered no treatment, group II was administered daily placebo enemas containing physiological saline, and group III was administered daily 2% L-Gln enemas. After sacrifice on postoperative day 5, anastomotic healing, burst pressure, tissue hydroxyproline levels, and histological parameters were measured, and group values were compared via statistical analysis.

Results

Group III was found to have the highest mean bursting pressure and tissue hydroxyproline levels and the lowest mean ischemia score. While the values of these parameters were not found to differ significantly among the groups, the lack of significance may have been due to the limited number of subjects examined.

Conclusion

Administration of a Gln enema may have a positive effect on anastomosis in terms of bursting pressure and histopathological parameters. Future research should examine administration of a preoperative Gln enema as a means of decreasing the traumatic effects of the enema and identifying its applicability in surgical practice.

Citations

Citations to this article as recorded by  
  • Effect of Glutamine on Short-term Surgical Outcomes in Rectal Cancer Patients Receiving Neoadjuvant Therapy: A Propensity Score Matching Study
    Gang Tang, Feng Pi, Zhengqiang Wei, Xiangshu Li
    Nutrition and Cancer.2023; 75(4): 1254.     CrossRef
  • Postoperative parenteral glutamine supplementation improves the short-term outcomes in patients undergoing colorectal cancer surgery: A propensity score matching study
    Gang Tang, Feng Pi, Yu-Hao Qiu, Zheng-Qiang Wei
    Frontiers in Nutrition.2023;[Epub]     CrossRef
  • The Effects of Hyperthermic Intraperitoneal Chemoperfusion on Colonic Anastomosis: An Experimental Study in a Rat Model
    Afag Aghayeva, Cigdem Benlice, Ismail Ahmet Bilgin, Pinar Atukeren, Gulen Dogusoy, Figen Demir, Deniz Atasoy, Bilgi Baca
    Tumori Journal.2017; 103(3): 307.     CrossRef
  • Topical Effect of Glutamine for Colorectal Anastomosis
    Jong-Woo Kim
    Annals of Coloproctology.2015; 31(6): 207.     CrossRef
Effects of Preoperative Chemoradiotherapy on the Healing of Colonic Anastomosis with the Lapse of Operation Time in the Rat.
Yun, Sung Su , Kim, Dong Sik , Kim, Chun Jik , Kim, Sang Woon , Kim, Jae Whang , Suh, Bo Yang , shim, Min Chul , Kwun, Kaing Bo , Sung, Un Ki
J Korean Soc Coloproctol. 1999;15(1):21-30.
  • 1,883 View
  • 2 Download
AbstractAbstract PDF
PURPOSE
Preoperative chemoradiotherapy has become an important adjunct in the management of rectal cancer. But both systemic toxicity of chemotherapy and local effect of radiation interfere wound healing of intestinal anastomosis and ultimately may lead to anastomotic leak and septic complications. The purpose of this study is to determine the optimal time interval between preoperative chemoradiotherapy and anastmotic construction, and it was evaluated by security of anastomotic construction.
METHODS
One hundred and twenty male Sprague Dawley rats weighing approximately 250 g were randomly divided into 4 groups (Control group; n=40, Group 1; n=20, Group 2; n=20, Group 3; n=40). The control group (n=20) underwent anastomotic construction at 1 week after general anesthesia without preoperative chemoradiotherapy. The experimental animals (group 1, 2, 3) received preoperative chemoradiotherapy with 5 daily dose (20 mg/kg) of 5-fluorouracil and single dose of 1500 cGy radiation at the rectosigmoid junction under general anesthesia on the day after last dose of chemotherapy. And group 1~3 subsequently underwent a laparotomy to make anastomotic construction at 1 week (Group 1), 2 weeks (Group 2), and 3 weeks (Group 3; n=20) after completion of chemoradiotherapy. The security of anastomotic construction was determined by bursting pressure, tissue hydroxyproline content, gross and microscopic findings of anastomotic area at the 5th and 10th postoperative day after anastomotic construction. To evaluate systemic toxicity after che-moradiotherapy, serial body weight and alteration of CBC were measured in the control group (n=20) and Group 3 (n=20) without anastomotic construction.
RESULTS
At the 5th postoperative day, Mean bursting pressures of the all treated groups were lower than that of the control group (Control group; 88 23 mmHg, Group 1; 49 22 mmHg, Group 2; 56 17 mmHg, Group 3; 78 23 mmHg). The difference was not significant in the group 3 compared with the control group. Body weight decreased in the all treated animals. The mean body weight was lowest on the day 8 after completion of chemoradiotherapy and then it gradually increased. WBC and platelet counts also decreased in the all treated animals. WBC count was lowest on the day 1 and platelet count was lowest on the day 3 after completion of chemoradiotherapy. Mean hydroxyproline contents at the anastomotic sites in the all treated groups were higher than that of the control group, especially in the group 2 and 3. Similar histologic changes were observed in both group 3 and control group.
CONCLUSION
The results suggest that the optimal time interval for safe intestinal anastomosis after preoperative chemoradiotherapy is 3 weeks or later.
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