TY - JOUR

T1 - Infliximab treatment reduces tensile strength in intestinal anastomosis

AU - Jensen, Jonas Sanberg

AU - Petersen, Nacie Bello

AU - Biagini, Matteo

AU - Bollen, Peter

AU - Qvist, Niels

N1 - Funding Information: Financial support was obtained from the Odense University Hospital foundation . Special thanks to the University of Southern Denmark; veterinarian Henrik Saxtorph, and the staff at the central animal facility, University of Southern Denmark; staff at the Clinical Pathological Institute at the University Hospital Odense. Thanks to Claire Gudex for linguistic revision. Søren Grønlund Nielsen and Rune Munch Trangbæk are acknowledged for invaluable cooperation during the study. Publisher Copyright: © 2015 Elsevier Inc. All rights reserved.

PY - 2015

Y1 - 2015

N2 - Background: The antitumor necrosis factor (infliximab [IFX]) has gained widespread use in the treatment of inflammatory bowel disease. However, several patients must undergo surgical treatment due to treatment failure and there is a potential risk that preoperative IFX treatment may have a negative effect on the healing process in intestinal anastomosis. The objective of this study was to examine the effect of repeated IFX treatment on anastomotic strength and degree of inflammation in the anastomotic line in the small intestine of rabbits. Methods: Thirty-two rabbits were randomized (2:1) to receive either repeated IFX treatment or placebo. On day 15, three separate end-to-end anastomoses were performed on the jejunum. On postoperative day 5, tensile strength and bursting pressure for the anastomoses were tested and histologic changes examined. Results: We found a significantly reduced tensile strength in the IFX group (1.94 ± 0.44 N) compared with the placebo group (3.33 ± 0.39 N), (P < 0.001). Calculation of Spearman correlation coefficients showed a positive significant correlation between minimal tensile strength and serum values of IFX (coefficient = -0.63; P = 0.003) as well as number of sutures in the tested anastomosis (coefficient = 0.51; P = 0.024). The general histologic score was significantly higher in the placebo group (5.00 ± 1.26 versus 3.31 ± 1.65, P = 0.03). Conclusions: Repeated high-dose IFX treatment reduces tensile strength significantly in rabbits and should be investigated further as a potential risk factor of anastomotic dehiscence in inflammatory bowel disease surgery.

AB - Background: The antitumor necrosis factor (infliximab [IFX]) has gained widespread use in the treatment of inflammatory bowel disease. However, several patients must undergo surgical treatment due to treatment failure and there is a potential risk that preoperative IFX treatment may have a negative effect on the healing process in intestinal anastomosis. The objective of this study was to examine the effect of repeated IFX treatment on anastomotic strength and degree of inflammation in the anastomotic line in the small intestine of rabbits. Methods: Thirty-two rabbits were randomized (2:1) to receive either repeated IFX treatment or placebo. On day 15, three separate end-to-end anastomoses were performed on the jejunum. On postoperative day 5, tensile strength and bursting pressure for the anastomoses were tested and histologic changes examined. Results: We found a significantly reduced tensile strength in the IFX group (1.94 ± 0.44 N) compared with the placebo group (3.33 ± 0.39 N), (P < 0.001). Calculation of Spearman correlation coefficients showed a positive significant correlation between minimal tensile strength and serum values of IFX (coefficient = -0.63; P = 0.003) as well as number of sutures in the tested anastomosis (coefficient = 0.51; P = 0.024). The general histologic score was significantly higher in the placebo group (5.00 ± 1.26 versus 3.31 ± 1.65, P = 0.03). Conclusions: Repeated high-dose IFX treatment reduces tensile strength significantly in rabbits and should be investigated further as a potential risk factor of anastomotic dehiscence in inflammatory bowel disease surgery.

KW - Gastrointestinal healing

KW - Infliximab

KW - Intestinal anastomosis

U2 - 10.1016/j.jss.2014.07.022

DO - 10.1016/j.jss.2014.07.022

M3 - Journal article

C2 - 25156230

AN - SCOPUS:84925031974

VL - 193

SP - 145

EP - 152

JO - Journal of Surgical Research

JF - Journal of Surgical Research

SN - 0022-4804

IS - 1

ER -