2010 Fiscal Year Final Research Report
Early Postoperative Oral Intake Accelerates Upper Gastrointestinal Anastomotic Healing : Its underlying mechanism and clinical application
| Project/Area Number |
20591541
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Single-year Grants |
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| Section | 一般 |
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| Research Field |
General surgery
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| Research Institution | University of Tsukuba |
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Principal Investigator |
TERASHIMA Hideo University of Tsukuba, 大学院・人間総合科学研究科, 講師 (10361338)
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| Co-Investigator(Kenkyū-buntansha) |
OHKOHCHI Nobuhiro 筑波大学, 大学院・人間総合科学研究科, 教授 (40213673)
KONDO Tadashi 筑波大学, 大学院・人間総合科学研究科, 准教授 (00375495)
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| Project Period (FY) |
2008 – 2010
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| Keywords | 代謝栄養外科学 |
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| Research Abstract |
Basic research : In our previous study, we reported that early postoperative oral feeding accelerated upper gastrointestinal anastomotic healing in rats. To investigate its underlying mechanism, we performed in vivo and in vitro experiments. Rats that received proximal jejunal anastomosis were divided into four groups: the enteral nutrition (EN) group were fed via gastrostomy, the total parental nutrition (TPN alone) group were fed via a venous catheter, the TPN + saline group received an additional administration of normal saline solution via gastrostomy, and the TPN + water group received an additional administration of distilled water via gastrostomy. The anastomotic bursting pressure (ABP) and the hydroxyproline content of the anastomotic tissue were measured 5 d postoperatively. In an in vitro setting, the rat gastrointestinal fibroblasts were subjected to uniaxial stretching for 60 min, and the expression of type I and type III collagen mRNA was evaluated. The ABP and hydroxyprol
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ine content in the EN group, the TPN + saline group, and the TPN + water group were significantly higher than those in the TPN alone group. The mRNA levels of type I and type III collagen were increased by stretch stimulation. In addition, the expression of ERK, AKT, STAT3 and p38 MAPK was significantly observed. These results suggest that mechanical loading plays a key role in anastomotic healing. Collaterally, we examined the effects of platelet-rich plasma (PRP) on intestinal anastomotic healing because platelet is regarded as a storage vehicle of growth factors and plays a key role in the early phase of intestinal anastomotic healing. As a result, PRP might exert positive effects on intestinal anastomotic healing in a dose-dependent manner up to a certain level, but adverse effects occur when it is highly concentrated (bimodal effect). The essential PRP action appears to be driven by the platelets themselves.
Clinical application : Based on above-mentioned studies, we delivered the following vision for clinical practice. Provided that anastomosis has been performed correctly, early postoperative oral intake after upper gastrointestinal anastomosis does not have a negative impact on anastomotic wound healing. There is a strong probability that early postoperative oral liquid intake accelerates upper gastrointestinal anastomotic healing compared with parenteral nutrition with a fasting period. We proposed that it is time to consider abolishing a period of starvation after upper gastrointestinal surgery. So, we demonstrated that postoperative early oral intake is feasible and safe as well as the experimental setting reported by us, also in an upper gastrointestinal operation with the high degree of surgical stress such as esophagectomy. Less
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