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Therapeutic improvement of colonic anastomotic healing under complicated conditions: A systematic review

World Journal of Gastrointestinal Surgery 2016年第5期8卷 389-401页

作者： malene nerstrom Peter-Martin Krarup Lars Nannestad Jorgensen Magnus S Agren Digestive Disease Center Bispebjerg Hospital University of Copenhagen DK-2400 Copenhagen NV Denmark Copenhagen Wound Healing Center Bispebjerg Hospital University of Copenhagen DK-2400 Copenhagen NV Denmark Department of Clinical Medicine Faculty of Health and Medical Sciences University of CopenhagenDK-2200 Copenhagen Denmark

AIM: To identify therapeutic agents for the prophylaxis of gastrointestinal anastomotic leakage(AL) under complicated conditions. METHODS: The Pub Med and EMBASE databases were searched for English articles published between January 1975 and September 2014. Studies with the primary purpose of improving anastomotic healing in the colon or rectum under complicated preoperative and/or intraoperative conditions were included. We excluded studies investigating the adverse effects or risk assessment of an active intervention. Furthermore, investigations of biophysical materials, sealants, electrical stimulation and nutrients were excluded. The primary study outcome was biomechanical anastomotic strength or AL. The meta-analysis focused on therapeutic agents that were investigated in one animal model using the same outcome by at least three independent research groups. RESULTS: The 65 studies included were divided into 7 different complicated animal models: Bowel ischemia, ischemia/reperfusion, bowel obstruction, obstructive jaundice, peritonitis, chemotherapy and radiotherapy. In total, 48 different therapeutic compounds were examined. The majority of investigated agents(65%) were reported as beneficial for anastomotic healing. Twelve of the agents(25%) were tested more than once in the same model, whereas 13(27%) of the agents were tested in two or more models of complicated healing. Two therapeutic agents met our inclusion criteria for the meta-analysis. Postoperative hyperbaric oxygen therapy significantly increased anastomoticbursting pressure in ischemic colon anastomoses by a mean of 28 mm Hg(95%CI: 17 to 39 mm Hg, P < 0.00001). Granulocyte macrophage-colony stimulating factor failed to show a significant increase in anastomotic bursting pressure(95%CI:-20 to 21 mmH g, P = 0.97) vs controls in experimental chemotherapeutic models. CONCLUSION: This systematic review identified potential therapeutic agents, but more studies are needed before concluding that any of the

关键词： Anastomotic healing Colorectal surgery Breaking strength Bursting pressure Anastomotic leakage Ischemia Chemotherapy Reperfusion Bowel obstruction Peritonitis Radiotherapy

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