Is combined therapy more effective than growth hormone or hyperbaric oxygen alone in the healing of left ischemic and non-ischemic colonic anastomoses?

• Published in: Clinics (São Paulo, Brazil) Vol. 68; no. 11; pp. 1440 - 1445
• Main Authors: Adas, Mine, Kemik, Ozgur, Adas, Gokhan, Arikan, Soykan, Kuntsal, Leyla, Kapran, Yersu, Toklu, Akin Savas
• Format: Journal Article
• Language: English
• Published: Brazil Elsevier España, S.L.U 01-11-2013; Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Faculdade de Medicina / USP; Elsevier España
• Subjects: Anastomosis, Surgical; Animals; Basic Research; Collagen - analysis; Colon - blood supply; Colon - pathology; Colon - surgery; Colonic Anastomoses; Combined Modality Therapy; Disease Models, Animal; Human Growth Hormone - therapeutic use; Hyperbaric Oxygen Treatment; Hyperbaric Oxygenation - methods; Ischemia - therapy; Male; MEDICINE, GENERAL & INTERNAL; Necrosis; Neovascularization, Physiologic; Pressure; Rats; Rats, Wistar; Recombinant Human Growth Hormone; Reproducibility of Results; Treatment Outcome; Wound Healing - drug effects; Recombinant Human Growth Hormone; Colonic Anastomoses; Hyperbaric Oxygen Treatment
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.6061/clinics/2013(11)10

Our aim was to investigate the effects of growth hormone (GH), hyperbaric oxygen and combined therapy on normal and ischemic colonic anastomoses in rats.
Eighty male Wistar rats were divided into eight groups (n = 10). In the first four groups, non-ischemic colonic anastomosis was performed, whereas in the remaining four groups, ischemic colonic anastomosis was performed. In groups 5, 6, 7, and 8, colonic ischemia was established by ligating 2 cm of the mesocolon on either side of the anastomosis. The control groups (1 and 5) received no treatment. Hyperbaric oxygen therapy was initiated immediately after surgery and continued for 4 days in groups 3 and 4. Groups 2 and 6 received recombinant human growth hormone, whereas groups 4 and 8 received GH and hyperbaric oxygen treatment. Relaparotomy was performed on postoperative day 4, and a perianastomotic colon segment 2 cm in length was excised for the detection of biochemical and mechanical parameters of anastomotic healing and histopathological evaluation.
Combined treatment with hyperbaric oxygen and GH increased the mean bursting pressure values in all of the groups, and a statistically significant increase was noted in the ischemic groups compared to the controls (p<0.05). This improvement was more evident in the ischemic and normal groups treated with combined therapy. In addition, a histopathological evaluation of anastomotic neovascularization and collagen deposition showed significant differences among the groups.
Combined treatment with recombinant human growth hormone and hyperbaric oxygen resulted in a favorable therapeutic effect on the healing of ischemic colonic anastomoses.