Colorectal anastomotic healing: why the biological processes that lead to anastomotic leakage should be revealed prior to conducting intervention studies

BMC Gastroenterology

Debate

Audrey C. H. M. Jongen¹  Joanna W. A. M. Bosmans¹  Nicole D. Bouvy¹  Joep P. M. Derikx² 

[1] Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands;NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands;NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, The Netherlands;Pediatric Surgical Center Amsterdam, Emma Children’s Hospital AMC/VUMC, P.O.Box 22660, 1100 DD, Amsterdam, The Netherlands;

关键词: Animal research;    Anastomotic healing;    Anastomotic leakage;    Colorectal anastomoses;    Colorectal surgery;    Healing process;    Wound healing;   

DOI  :  10.1186/s12876-015-0410-3

 received in 2015-09-23, accepted in 2015-12-10,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundAnastomotic leakage (AL) remains the most dreaded complication after colorectal surgery and causes high morbidity and mortality. The pathophysiology of AL remains unclear, despite numerous studies that have been conducted on animals and humans, probably due to the undetermined healing process of colorectal anastomoses. Increasing basic knowledge on this healing process may shed more light on causal factors of AL, and additionally reduce the quantity and accelerate the quality of experimental studies. In this debate article, our aim was to provide different perspectives on what is known about the colorectal healing process in relation to wound healing and AL.DiscussionSince knowledge on anastomotic healing is lacking, it remains difficult to conclude which factors are essential in preventing AL. This is essential information in the framework of humane animal research, where the focus should lie on Replacement, Reduction and Refinement (3Rs). While many researchers compare anastomotic healing with wound healing in the skin, there are substantial recognized differences, e.g. other collagen subtypes and different components involved.SummaryBased on our findings in literature as well as discussions with experts, we advocate stop considering anastomotic healing in the gastrointestinal tract and cutaneous healing as a similar process. Furthermore, intervention studies should at least address the anastomotic healing process in terms of histology and certain surrogate markers. Finally, the anastomotic healing process ought to be further elucidated – with modern techniques to achieve 3Rs in animal research - to provide starting points for potential interventions that can prevent AL.

【 授权许可】

CC BY   
© Bosmans et al. 2015