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P062 PREBIOTICS AND THE INFLUENCE ON INTESTINAL WOUND HEALING
Liver and Gastrointestinal Tract I PN and ER12 groups, the survival rates at early time points appear to be better in the ER12 than in the PN group (survival rates at 24, 48 and 72 hours; 63%, 50% and 38% in the ER12 group, 33%, 22% and 22% in the PN group). Conclusion: ER quickly restores PN-induced impairment of hepatic immunity. However, the recovery of both hepatic MNC number and function is needed for full restoration of resistance to bacterial challenge. Disclosure of Interest: There are no potential conflicts of interest any of the authors. There are no sources of outside support for research, including funding, equipment and drugs.
P062 PREBIOTICS AND THE INFLUENCE ON INTESTINAL WOUND HEALING J.G. Bloemen1 , M.H.F. Schreinemacher1 , M. Gijbels2 , K. Venema3 , W.A. Buurman1 , N.D. Bouvy1 , C.H.C. Dejong1 . 1 General Surgery, 2 Pathology, Maastricht University Medical Centre, Maastricht; 3 TNO, TI Food & Nutrition, Wageningen, Netherlands Rationale: Intestinal healing is a complex and dynamic process, classically divided in three stages: inflammation, proliferation and remodeling. Inulin is a prebiotic, of which anti-inflammatory properties are described. Since anastomotic leakage is a common problem in colorectal surgery, an intervention to enhance intestinal healing is welcome. The aim of the present study was to investigate the effects of oral inulin on intestinal healing. Methods: Wistar rats (250 350 gr) underwent a 1 cm left colonic resection followed by an end-to-end anastomosis with 4 interrupted, nonabsorbable sutures. Group I received 2 gr of inulin orally, daily, starting 7 days preoperatively and continuing postoperatively. Group II underwent no other treatment (control). On the 3rd or 7th postoperative day, rats (n = 9 per time point) were anesthetized, anastomotic bursting strength was evaluated and the anastomotic specimen was resected for histological evaluation. Results: Bursting pressures did not differ significantly at day 3 (73 vs. 53 mmHg, p = 0.40) and day 7 (108 vs. 118 mmHg, p = 0.73) between the inulin fed and control group, respectively. At day 3 MPO staining showed absence of granulocyte-influx at the anastomotic region and less ED1 (tissue macrophages) staining in the inulinfed group, compared to the control group. Morphologic evaluation with HE staining showed mucosal bleeding and transluminal necrosis in the inulin fed group at day 7. Conclusion: Peri-operative inulin feeding leads to inhibition of the inflammatory response after 3 days and to mucosal bleeding and transluminal necrosis after 7 days. The inhibition of the inflammatory response may prevent an impaired healing process. Furthermore, the relative overload of fibers may cause a strong increase of short chain fatty acids and lactate concentration, that lead to a suboptimal environment for wound healing. Disclosure of Interest: None declared.
51 P063 BUTYRATE TO IMPROVE INTESTINAL ANASTOMOTIC STRENGTH; FRIEND OR FOE? J.G. Bloemen1 , M.H.F. Schreinemacher1 , M. Gijbels2 , K. Venema3 , W.A. Buurman1 , N.D. Bouvy1 , C.H.C. Dejong1 . 1 General Surgery, 2 Pathology, Maastricht University Medical Centre, Maastricht; 3 TNO, TI Food & Nutrition, Wageningen, Netherlands Rationale: Anastomotic leakage is a common clinical complication with incidences up to 10 17% in colorectal surgery.Butyrate is the product of fermentation of carbohydrates in the colon and is considered to be beneficial in gastro-intestinal healing. The aim of this study was to investigate the effect of intraluminal supplementation of butyrate on anastomotic strength in a rat model. Methods: Wistar rats (250 350 gr) were randomly assigned to one of 3 groups (18 animals each). All rats underwent a 1 cm left colonic resection followed by an end-to-end anastomosis with 4 interrupted, nonabsorbable sutures. Group I received enemas containing 5 mls of 60 mM sodium butyrate postoperatively, daily, whereas Group II received 5 mls of placebo enemas. Group III underwent no other treatment and served as control. On the 3rd or 7th postoperative day, rats (n = 9 per time point) were anesthetized, anastomotic bursting strength was evaluated and the anastomotic specimen was resected for histological evaluation. Results: As a consequence of anastomotic leakage, 1 rat (5.6%) in group I, 4 (22.2%) rats in group II and 3 rats (16.6%) in group III died. Mean anastomotic bursting pressures at day 3 were not significantly different between groups (p > 0.40). At day 7, bursting pressures were significantly higher in the butyrate enema group (225 mmHg) compared to the control (118 mmHg) and placebo group (153 mmHg) (p < 0.01). Sirius red staining showed a decreased young/maturated collagen ratio in the butyrate enema group (0.87 vs. 1.4 and 1.5). Histological evaluation with HE staining did not reveal any morphological difference between groups. MPO and ED1 (tissue macrophages) did not reveal a difference between the groups in inflammatory parameters. Conclusion: Postoperative intraluminal butyrate supplementation enhances anastomotic bursting strength in a left sided partial colonic resection rat model. It leads to relatively more maturated collagen at the anastomotic site, which increases the anastomotic strength. Disclosure of Interest: None declared.
P062 PREBIOTICS AND THE INFLUENCE ON INTESTINAL WOUND HEALING J.G. Bloemen1 , M.H.F. Schreinemacher1 , M. Gijbels2 , K. Venema3 , W.A. Buurman1 , N.D. Bouvy1 , C.H.C. Dejong1 . 1 General Surgery, 2 Pathology, Maastricht University Medical Centre, Maastricht; 3 TNO, TI Food & Nutrition, Wageningen, Netherlands Rationale: Intestinal healing is a complex and dynamic process, classically divided in three stages: inflammation, proliferation and remodeling. Inulin is a prebiotic, of which anti-inflammatory properties are described. Since anastomotic leakage is a common problem in colorectal surgery, an intervention to enhance intestinal healing is welcome. The aim of the present study was to investigate the effects of oral inulin on intestinal healing. Methods: Wistar rats (250 350 gr) underwent a 1 cm left colonic resection followed by an end-to-end anastomosis with 4 interrupted, nonabsorbable sutures. Group I received 2 gr of inulin orally, daily, starting 7 days preoperatively and continuing postoperatively. Group II underwent no other treatment (control). On the 3rd or 7th postoperative day, rats (n = 9 per time point) were anesthetized, anastomotic bursting strength was evaluated and the anastomotic specimen was resected for histological evaluation. Results: Bursting pressures did not differ significantly at day 3 (73 vs. 53 mmHg, p = 0.40) and day 7 (108 vs. 118 mmHg, p = 0.73) between the inulin fed and control group, respectively. At day 3 MPO staining showed absence of granulocyte-influx at the anastomotic region and less ED1 (tissue macrophages) staining in the inulinfed group, compared to the control group. Morphologic evaluation with HE staining showed mucosal bleeding and transluminal necrosis in the inulin fed group at day 7. Conclusion: Peri-operative inulin feeding leads to inhibition of the inflammatory response after 3 days and to mucosal bleeding and transluminal necrosis after 7 days. The inhibition of the inflammatory response may prevent an impaired healing process. Furthermore, the relative overload of fibers may cause a strong increase of short chain fatty acids and lactate concentration, that lead to a suboptimal environment for wound healing. Disclosure of Interest: None declared.
51 P063 BUTYRATE TO IMPROVE INTESTINAL ANASTOMOTIC STRENGTH; FRIEND OR FOE? J.G. Bloemen1 , M.H.F. Schreinemacher1 , M. Gijbels2 , K. Venema3 , W.A. Buurman1 , N.D. Bouvy1 , C.H.C. Dejong1 . 1 General Surgery, 2 Pathology, Maastricht University Medical Centre, Maastricht; 3 TNO, TI Food & Nutrition, Wageningen, Netherlands Rationale: Anastomotic leakage is a common clinical complication with incidences up to 10 17% in colorectal surgery.Butyrate is the product of fermentation of carbohydrates in the colon and is considered to be beneficial in gastro-intestinal healing. The aim of this study was to investigate the effect of intraluminal supplementation of butyrate on anastomotic strength in a rat model. Methods: Wistar rats (250 350 gr) were randomly assigned to one of 3 groups (18 animals each). All rats underwent a 1 cm left colonic resection followed by an end-to-end anastomosis with 4 interrupted, nonabsorbable sutures. Group I received enemas containing 5 mls of 60 mM sodium butyrate postoperatively, daily, whereas Group II received 5 mls of placebo enemas. Group III underwent no other treatment and served as control. On the 3rd or 7th postoperative day, rats (n = 9 per time point) were anesthetized, anastomotic bursting strength was evaluated and the anastomotic specimen was resected for histological evaluation. Results: As a consequence of anastomotic leakage, 1 rat (5.6%) in group I, 4 (22.2%) rats in group II and 3 rats (16.6%) in group III died. Mean anastomotic bursting pressures at day 3 were not significantly different between groups (p > 0.40). At day 7, bursting pressures were significantly higher in the butyrate enema group (225 mmHg) compared to the control (118 mmHg) and placebo group (153 mmHg) (p < 0.01). Sirius red staining showed a decreased young/maturated collagen ratio in the butyrate enema group (0.87 vs. 1.4 and 1.5). Histological evaluation with HE staining did not reveal any morphological difference between groups. MPO and ED1 (tissue macrophages) did not reveal a difference between the groups in inflammatory parameters. Conclusion: Postoperative intraluminal butyrate supplementation enhances anastomotic bursting strength in a left sided partial colonic resection rat model. It leads to relatively more maturated collagen at the anastomotic site, which increases the anastomotic strength. Disclosure of Interest: None declared.