Effects of neurotensin on the healing of experimental anastomosis of the colon

The leakage of colonic anastomoses increases perioperative morbidity significantly. The purpose of the study was to investigate the influence of neurotensin, an intestinal trophic peptide, on the healing of colonic anastomosis. Forty-two Wistar-albino rats were separated into three equal groups : Group 1 (control group) - segmental resection of the left colon and end-to-end anastomosis. Group 2 (dexamethasone group) - resection and anastomosis, plus 0.1 mg/kg/day of dexamethasone; Group 3 (neurotensin group) - same surgical procedure plus 300 pg/kg/day of neurotensin. Bursting pressure and tissue hydroxyproline content were determined as parameters of the anastomosis strength and healing on the 3(rd) and 7(th) days postoperatively. On the 31 day, mean bursting pressures were 141.4, 146.7 and 73.1 (p = 0.0001) cm of water in the control group, dexamethasone and neurotensin groups respectively. On the 7(th) day, bursting pressures were measured as 237.4, 100.6 (p = 0.0001) and 72.7(p = 10(-6)) cm of water, in the control group, dexamethasone and neurotensin groups respectively. Between the 3(rd) and 7(th) days, bursting pressures were increased significantly in the control group (p = 0.0001), decreased in the dexamethasone (p = 0.048), and maintained their lowest values in the neurotensin (p = 0.96) groups. On the 7(th) day, mean hydroxyproline levels were measured as 9.20, 3.30 (p = 0.007), 2.86 (p = 0.007) mug, in the control group, dexamethasone, and neurotensin groups respectively. Between the 3(rd) and 7(th) days, tissue hydroxyproline levels were increased significantly in the control group (p = 0.004), decreased in the dexamethasone (p = 0.03), and maintained their lowest values in the neurotensin (p = 0.87) groups. The anastomosis resistance to intraluminal pressure was weak, tissue collagen content was insufficient, and healing was inadequate in the dexamethasone and neurotensin groups in respect to the control group. We concluded that neurotensin impaired the healing, and affected the strength of the colonic anastomosis

Does the approach to the groin make a difference in hernia repair?

PubMed ID: 17610024Background: Laparoscopic and open preperitoneal hernia repair techniques both use the preperitoneal space. This study investigated whether the surgical approach to the inguinal canal affects outcome measures. Methods: One hundred sixty patients with inguinal hernia were assigned randomly into open anterior (42), open preperitoneal (39), laparoscopic transabdominal preperitoneal (39), and laparoscopic total extraperitoneal (40) groups according to the surgical method. The peroperative serum tumor necrosis factor-? (TNF-?) levels, interleukin-6 (IL-6) levels, VAS scores at 6 and 48 h, per- and postoperative complications, and recurrence rates were determined as main variables. Results: The serum IL-6 levels were 335 ± 1.8, 283 ± 1.8, 283 ± 1.4, and 269.3 ± 1.6 pg/ml in the open anterior, posterior, transabdominal preperitoneal, and total extraperitoneal groups, respectively (P < 0.01). The TNF-? levels were highest in the open anterior group. The pain scores were lower in groups undergoing the posterior approach than in the open anterior approach group. Conclusion: The approach to the inguinal canal through the preperitoneal space appears to be less invasive than the transinguinal anterior approach. © Springer-Verlag 2007