Clinical review: Healing in gastrointestinal anastomoses, Part II

Complications arising from gastrointestinal anastomosis failures are a major source of morbidity and mortality. This review examines the effects of local blood flow on anastomotic healing, and discusses strategies for improving perfusion. Disruption of blood supply plays a significant role in the de...

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Bibliographic Details
Published in:Microsurgery 2006, Vol.26 (3), p.137-143
Main Authors: Enestvedt, C. Kristian, Thompson, Sarah K., Chang, Eugene Y., Jobe, Blair A.
Format: Article
Language:English
Subjects:
Anastomosis, Surgical
Animals
Biological and medical sciences
Esophagectomy
Gastrointestinal Diseases - surgery
General aspects
Humans
Ischemia - physiopathology
Ischemic Preconditioning
Medical sciences
Microcirculation
Neovascularization, Physiologic - physiology
Omentum - surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical Flaps
Surgical Wound Dehiscence - physiopathology
Vascular Endothelial Growth Factor A - physiology
Wound Healing - physiology
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Summary:Complications arising from gastrointestinal anastomosis failures are a major source of morbidity and mortality. This review examines the effects of local blood flow on anastomotic healing, and discusses strategies for improving perfusion. Disruption of blood supply plays a significant role in the development of anastomotic leakage. Several methods have been suggested to improve perfusion. Omental pedicles have been employed as buttresses to promote angiogenesis, but efficacy in preventing anastomotic dehiscence has not been established. The administration of exogenous pharmacologic agents (such as vascular endothelial growth factor) is another potential strategy, although the oncological safety of this approach has been questioned. Two techniques which show promise in reducing anastomotic leakage rates include the vascular augmentation of grafts at risk for ischemia (supercharging) and ischemic conditioning (utilizing the delay phenomenon). Further studies of these strategies are needed to establish their efficacy and safety for routine use in gastrointestinal anastomoses. © 2006 Wiley‐Liss, Inc. Microsurgery, 2006.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.20198