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P357. The impact of peri-operative administration of infliximab on post-operative complication rates: a rat experimental study

C. Zeglinas1, I. Papaconstantinou2, M. Gazouli3, C. Nastos2, A. Yiallourou2, C. Evagelou4, I. Vlahogiannakos5, K. Tsimaratou3, A. Papalois6, C. Tzathas1, 1Tzaneion, Gastroenterology, Piraeus, Greece, 2Areteion, Surgery, Athens, Greece, 3Molecular carcinigenesis group, Laboratory of Histology and Embryology, Athens, Greece, 4Medical School, Pathology, Athens, Greece, 5Laikon Hospital, Internal Medicine, Athens, Greece, 6Experimental-Research Unit, ELPEN-Pharmaceuticals Co. Inc, Pikermi, Greece

Background

The impact of anti-TNF's peri-operative administration on post-operative complication rates was evaluated in numerous studies. However, all are retrospective with significant limitations. The aim of this experimental study was to investigate the effect of peri-operative anti-TNF infusion on intestinal anastomotic healing process in rats.

Methods

Fifty-six adult Wistar rats were allocated in 4 groups: (a) 20 subjected to excision of part of the terminal ileum followed by anastomosis, and biopsized on the 3rd or the 7th post-operative day after which animals were sacrificed; (b) 20 received Infliximab and thereafter a same strategy to group (a) was followed; (c) 8 received Infliximab and served as relative control group; and (d) 8 with no intervention served as absolute control group.

Rats of (b) and (c) groups received subcutaneous injections of 5 mg/kg infliximab on days 0, 3, 6, 9, 12 and underwent surgery 3 days after the completion of administration.

The quality of anastomosis was assessed macroscopically for any septic complication. In addition, cellular infiltration and architectural parameters of anastomosis were evaluated in hematoxylin and eosin-stained sections. Bursting pressure analysis was also used for testing intestinal healing. All parameters assessing the repair process were estimated at 3 and 7 post-operative day.

Results

No significant difference was observed between non-IFX (a) group and IFX-treated (b) group in abscess formation rates at 3rd (5/9 vs 3/9, p = 0.34) and 7th (0/9vs 0/7) post-operative day.

Bursting pressures were not differing significantly among non-IFX (a) and IFX-treated (b) groups at both 3rd (6.8±7 vs 37.25±38.17 mmHg, p = 0.41) and 7th (104.2±41.6 vs 89.8±14 mmHg, p = 0.42) post-operative days. Of note the anostomotic bursting pressure in groups (a) and (b) was significantly lower (p < 0.01) compared to rats that had not undergone intestinal anastomosis (groups c,d). In addition, bursting pressure increased abruptly between days 3 and 7 in both groups (a) (p = 0.008) and (b) (p = 0.032).

At both 3 and 7 post-operative days a more intense inflammatory reaction with higher cell infiltration rate was observed in non-IFX (a) group compared to IFX-treated (b) group.

Conclusion

Both post-operative septic complications rate and anastomotic bursting pressure seems not to be affected significantly by the administration of Infliximab peri-operatively.

Histological evaluation revealed a trend of increased inflammatory cell infiltration in non-IFX treated group.