Immediate and Delayed Surgical Repair of Duodenal Defects in Rats with Small Intestinal Submucosa Patch

• Authors: Dimosthenis Miliaras , Spyridon Miliaras , Soultana Meditskou , Theodora Papamitsou
• Languages of publication: EN

Abstracts

EN

Duodenal injuries, though rare, carry high rates of morbidity and mortality. The aim of the study was to evaluate the healing of the duodenal wall with the use of a Small Intestinal Submucosa (SIS) patch. Material and methods. We studied 40 Whistar-Albino rats divided into two groups. In group A, we created a small defect in the duodenal wall, which was immediately covered with a SIS patch. In group B, the SIS patch was sutured over the defect after 6-8 hours, in order to induce peritonitis. The animals of both groups were sacrificed after 2, 6, 12 and 16 weeks respectively. In addition, we studied the immunohistochemical expression of TGF-β, which is a major constituent of SIS, and plays a central role in the healing process. Results. Histology showed progressive development of the layers of the duodenal wall over the patch as early as the 2nd week in some of the animals of group A. Mucosa developed later on in the animals of group B, presumably due to the more intense inflammation elicited by peritonitis. Expression of TGF-β was initially more pronounced in the epithelial cells of the regenerating mucosa of animals of group A, but it was maintained in higher levels in the animals of group B, which showed delayed mucosa degeneration. Conclusions. SIS appears to be both efficient and safe for the management of duodenal trauma. TGF-β seems to play an important role in the healing process, inducing regeneration of the stroma, and controling epithelial growth.

Keywords

EN

duodenal defect; healing; immunohistochemistry; regeneration; small intestinal submucosa; TGF-β

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2015
• Volume: 86
• Issue: 3
• Pages: 116-121

Dates

published

1 - 3 - 2014

received

15 - 1 - 2014

online

25 - 4 - 2014

Contributors

author

Dimosthenis Miliaras

• Laboratory of Histology and Embryology, School of Medicine, Aristotle University,Thessaloniki, Greece

author

Spyridon Miliaras

• 1st Department of Surgery, Papageorgiou Hospital, School of Medicine, Aristotle University,Thessaloniki, Greece

author

Soultana Meditskou

• Laboratory of Histology and Embryology, School of Medicine, Aristotle University,Thessaloniki, Greece

author

Theodora Papamitsou

• Laboratory of Histology and Embryology, School of Medicine, Aristotle University,Thessaloniki, Greece

References

• 1. Jensen M, Du Toit D, Warren B: Duodenal injuries: surgical management adapted to circumstances. Injury 2002; 33: 611-15.[Crossref]
• 2. Blocksom JM , Tyburski JG, Sohn RL et al.: Prognostic determinants in duodenal injuries. Am Surg 2004; 70: 248-55.[PubMed]
• 3. Asensio JA , Petrone P, Roldan G et al.: Pancreatic and duodenal injuries. Complex and lethal. Scand J Surg 2002; 91: 81-86.[PubMed]
• 4. Bernard AC , Barnes SL , Boulanger BR: Multilevel blunt duodenal injury. J Trauma 2004; 57: 1108-10.[Crossref][PubMed]
• 5. Britt LD : Duodenal primary repair. Diversion and exclusion. Oper Tech Gen Surg 2000; 2: 234-39.[Crossref]
• 6. Kobolt EE, Thal AP: A simple method for the management of experimental wounds of the duodenum. Surg Gynecol Obst 1963; 116: 340-44.
• 7. De Ugarte DA , Choi E, Weitzbuch H et al.: Mucosal regeneration of a duodenal defect using small intestine submucosa. Am Surg 2004; 70: 49-51.[PubMed]
• 8. Chen MK , Badylak SF: Small bowel tissue engineering using Small Intestinal Submucosa as a scaffold. J Surg Res 2001; 99: 352-58.[WoS]
• 9. Souza Filho ZA , Greca FH, Rocha SL et al.: Porcine submucosa graft for the treatment of duodenal injuries in dogs. Acta Cir Bras 2005; 20: 394-98.[PubMed]
• 10. Lee M, Chang PC, Dunn JC : Evaluation of small intestinal submucosa as scaffolds for intestinal tissue engineering. J Surg Res 2008; 147: 168-71.
• 11. de la Fuente S, Gottfried M, Lawson D et al.: Evaluation of porcine derived small intestinal submucosa as a biodegradable graft for gastrointestinal healing. J Gastrointest Surg 2003; 7: 96-101.
• 12. Mezzano S, Burgos ME, Olavarría F et al.: Immunohistochemical localization of IL-8 and TGF-beta in streptococcal glomerulonephritis. J Am Soc Nephrol 1997; 8: 234-41.
• 13. Marinova-Mutafchieva L, Gabay C, Funa K et al.: Remission of collagen-induced arthritis is associated with high levels of transforming growth factor-beta expression in the joint. Clin Exp Immunol 2006; 146: 287-93.
• 14. Broadley KN , Quaglino D: Reversal of the wound healing deficit in diabetic rats by combined basic fibroblast growth factor and transforming growth factor-beta1 therapy. Wound Repair Regen 1997; 5: 77-88.[PubMed]
• 15. Thorup I: Histomorphological and immunohistochemical characterization of colonic aberrant crypt foci in rats: relationship to growth factor expression. Carcinogenesis 1997; 18: 465-72.[PubMed][Crossref]
• 16. Matsushita M, Matsuzaki K, Date M et al.: Down-regulation of TGF-beta receptors in human colorectal cancer: implications for cancer development. Br J Cancer 1999; 80: 194-205.[PubMed][Crossref]
• 17. Barnard JA , Warwick GJ, Gold LI : Localization of transforming growth factor beta isoforms in the normal murine small intestine and colon. Gastroenterology 1993; 105: 67-73.[PubMed]
• 18. Shell DH 4th, Croce MA , Cagiannos C et al.: Comparison of small-intestinal submucosa and expanded polytetrafluoroethylene as a vascular conduit in the presence of gram-positive contamination. Ann Surg 2005; 241: 995-1004.
• 19. Rosen M, Ponsky J, Petras R et al.: Small intestinal submucosa as a bioscaffold for biliary tract regeneration. Surgery 2002; 132: 480-86.
• 20. Record RD, Hillegonds D, Simmons C et al.: In vivo degradation of 14C-labeled small intestinal submucosa (SIS) when used for urinary bladder repair. Biomaterials 2001; 22: 2653-59.[Crossref]
• 21. Cobb MA , Badylak SF, Janas W et al.: Porcine small intestinal submucosa as a dural substitute. Surg Neurol 1999; 51: 99-104.
• 22. Ueno T, de la Fuente SG, Abdel-Wahab OI et al.: Functional evaluation of the grafted wall with porcine- derived small intestinal submucosa (SIS) to a stomach defect in rats. Surgery 2007; 142: 376-83.
• 23. Hoeppner J, Crnogorac V, Marjanovic G et al.: Small intestinal submucosa as a bioscaffold for tissue regeneration in defects of the colonic wall. J Gastrointest Surg 2009; 13: 113-19.[PubMed][Crossref][WoS]
• 24. Seok J, Warren HS, Cuenca AG et al.: Inflammation and Host Response to Injury, Large Scale Collaborative Research Program. Genomic responses in mouse models poorly mimic human inflammatory diseases. Proc Natl Acad Sci USA 2013; 110: 3507-12. [Crossref]

Identifiers

DOI

10.2478/pjs-2014-0022