Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2015, vol. 24, nr 3, May-June, p. 463–467

doi: 10.17219/acem/43877

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

The Effects of Early Enteral Nutrition Products on the Healing of Colo-Colonic Anastomosis

Mustafa Sit1,A,B,D,F, Ahmet S. Ilgun2,B,C, Oguz Catal3,A,B, Ferda N. Koksoy4,C,E, Gülali Aktas5,E,F, Alper Cihan6,A,C

1 Department of General Surgery, Abant Izzet Baysal University Hospital, Bolu, Turkey

2 Department of General Surgery, Cayeli State Hospital, Rize, Turkey

3 Department of General Surgery, Ardahan State Hospital, Ardahan, Turkey

4 Department of General Surgery, Taksim Training and Education Hospital, Istanbul, Turkey

5 Department of Internal Medicine, Abant Izzet Baysal University Hospital, Bolu, Turkey

6 Department of General Surgery, Istanbul University, Istanbul, Turkey

Abstract

Objectives. Complications after colorectal surgery have not been reduced in recent years. Anastomotic leakage is responsible for nearly all morbidity in colonic surgery and for about one third of the mortality.
Material and Methods. For the study, 34 albino Wistar rats (about 155–190 g in weight) were divided into four experimental groups. Each of the rats underwent an abdominal incision and resection of the colon 4 cm distal to the cecum to form a colo-colonic anastomosis. In the post-operative period, the first group (n = 8) were fed with standard rat food and water, the second group (n = 9) with dextrose + Ringer solution, the third group (n = 9) with Biosorb® (Nutricia, Zoetermeer, The Netherlands), and the fourth group (n = 8) with Impact® (Novartis Nutrition, USA).
Results. The blow-out pressure of the anastomoses was significantly different in the group fed 5% dextrose + + Ringer solution group than in the Biosorb® and Impact® groups.
Conclusion. None of the various nutrients investigated in the present study were significantly superior to standard foods in terms of the blow-out pressures. On the other hand, immunonutrients were more beneficial effects than other nutrients in terms of the healing of colonic anastomoses and post-operative weight loss.

Key words

anastomosis, nutrition, healing.

References (28)

  1. Schrock TR, Deveney CW, Dunphy JE: Factor contributing to leakage of colonic anastomoses. Ann Surg 1973, 177, 513.
  2. Koruda MJ, Rolandelli RH: Experimental Studies on the Healing of Colonic Anastomoses. J Surg Res 1990, 48, 504–515.
  3. Telem DA, Chin EH, Nguyen SQ, Divino CM: Risk factors for anastomotic leak following colorectal surgery: a case-control study. Arch Surg 2010, 145, 371–376, discussion 6. Epub 2010/04/21.
  4. Kiyama T, Efron DT, Tantry U, Barbul A: Effect of nutritional route on colonic anastomotic healing in the rat. J Gastrointest Surg 1999, 3, 441–446.
  5. Osland E, Yunus RM, Khan S, Memon MA: Early versus traditional postoperative feeding in patients undergoing resectional gastrointestinal surgery: a meta-analysis. JPEN 2011, 35, 473–487. Epub 2011/06/02.
  6. Tadano S, Terashima H, Fukuzawa J, Matsuo R, Ikeda O, Ohkohchi N: Early postoperative oral intake accelerates upper gastrointestinal anastomotic healing in the rat model. J Surg Res 2011, 169, 202–208. Epub 2010/04/28.
  7. Rolandelli RH, Koruda MJ, Settle RG, Rombeau JL: Effects of intraluminal infusion of short-chain fatty acids on the healing of colonic anastomosis in the rat. Surgery 1986, 100, 198–204. Epub 1986/08/01.
  8. Rousselot LM, Slattery JR: Immediate Complications of Surgery of the Large Intestine. The Surg Clin North Am 1964, 44, 397–410. Epub 1964/04/01.
  9. Hawley PR: Causes and prevention of colonic anastomotic breakdown. Dis Colon Rectum 1973, 16, 272–277. Epub 1973/07/01.
  10. Irvin TT, Goligher JC: Aetiology of disruption of intestinal anastomoses. B J Surg 1973, 60, 461–464. Epub 1973/06/01.
  11. Jiborn H, Ahonen J, Zederfeldt B: Healing of experimental colonic anastomoses. The effect of suture technic on collagen concentration in the colonic wall. Am J Surg 1978, 135, 333–340. Epub 1978/03/01.
  12. van der Ham AC, Kort WJ, Weijma IM, van den Ingh HF, Jeekel J: Effect of fibrin sealant on the healing colonic anastomosis in the rat. B J Surgery. 1991, 78, 49–53. Epub 1991/01/01.
  13. Thornton M, Joshi H, Vimalachandran C, Heath R, Carter P, Gur U, Rooney P: Management and outcome of colorectal anastomotic leaks. Int J Colorectal Dis 2011, 26, 313–320. Epub 2010/11/26.
  14. Wise L, McAlister W, Stein T, Schuck P: Studies on the healing of anastomoses of small and large intestines. Surg Gynecol Obstet 1975, 141, 190–194. Epub 1975/08/01.
  15. Yale C, Van Gemert J: Healing of inverted and everted intestinal anastomoses in germfree rats. Surgery 1971, 69, 382.
  16. McSherry CK, Grafe WR, Jr., Perry HS, Glenn F: Surgery of the large bowel for emergent conditions. Staged vs. primary resection. Arch Surg 1969, 98, 749–753. Epub 1969/06/01.
  17. Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA, Kuhl MR, Brown RO: Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 1992, 215, 503–511, discussion 11–13. Epub 1992/05/01.
  18. Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM, Jr, Welling RE, Moore EE: Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 1992, 216, 172–183. Epub 1992/08/11.
  19. Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM: TEN versus TPN following major abdominal trauma-reduced septic morbidity. J Trauma 1989, 29, 916–922, discussion 22–23. Epub 1989/07/01.
  20. Li J, Kudsk KA, Gocinski B, Dent D, Glezer J, Langkamp-Henken B: Effects of parenteral and enteral nutrition on gut-associated lymphoid tissue. J Trauma 1995, 39, 44–51, discussion – 2. Epub 1995/07/01.
  21. King BK, Li J, Kudsk KA: A temporal study of TPN-induced changes in gut-associated lymphoid tissue and mucosal immunity. Arch Surg 1997, 132, 1303–1309. Epub 1997/12/24.
  22. Jie B, Jiang ZM, Nolan MT, Efron DT, Zhu SN, Yu K, Kondrup J: Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition 2010, 26, 1088–1093.
  23. Lowry SF: The Route of Feeding Influences Injury Responses. Journal of Trauma-Injury Infection and Critical Care 1990, 30, S10–S5.
  24. Meyer J, Yurt RW, Duhaney R, Hesse DG, Tracey KJ, Fong Y, Richardson D, Calvano S, Dineen P, Shires GT, Lowry SF, Davis JM: Differential Neutrophil Activation before and after Endotoxin Infusion in Enterally Versus Parenterally Fed Volunteers. Surg Gynecol Obstet 1988, 167, 501–509.
  25. Cihan A, Oguz M, Acun Z, Ucan BH, Armutcu F, Gurel A, Ulukent SC: Comparison of early postoperative enteral nutrients versus chow on colonic anastomotic healing in normal animals. Eur Surg Res 2004, 36, 112–115.
  26. Fukuzawa J, Terashima H, Ohkohchi N: Early postoperative oral feeding accelerates upper gastrointestinal anastomotic healing in the rat model. World J Surg 2007, 31, 1236–1241.
  27. Kiyama T, Efron DT, Tantry U, Barbul A: Effect of nutritional route on colonic anastomotic healing in the rat. J Gastrointest Surg 1999, 3, 441–446. Epub 1999/09/11.
  28. Sax HC, Illig KA, Ryan CK, Hardy DJ: Low dose enteral feeding is beneficial during total parenteral nutrition. Am J Surg 1996, 171, 587–590.