Ann Surg Treat Res.  2018 Dec;95(6):312-318. 10.4174/astr.2018.95.6.312.

Effects of acute normovolemic hemodilution on healing of gastric anastomosis in rats

• Kim TY
• Kim DW
• Jeong MA
• Jun JH
• Min SJ
• Shin SJ
• Ha TK
• Choi D

• KMID: 2426762
• DOI: http://doi.org/10.4174/astr.2018.95.6.312

Abstract

PURPOSE
Acute normovolemic hemodilution (ANH) is an autologous transfusion method, using blood collected during surgery, to reduce the need for allogeneic blood transfusion. ANH is controversial because it may lead to various complications. Among the possible complications, anastomotic leakage is one that would have a significant effect on the operation outcome. However, the relationship between ANH and anastomotic site healing requires additional research. Therefore, we conducted this prospective study of ANH, comparing it with standard intraoperative management, undergoing gastric anastomosis in rats.
METHODS
Sixteen Sprague-Dawley rats were randomly assigned to three groups: group A, surgery with ANH; group N, surgery with standard intraoperative management; and group C, sham surgery with standard intraoperative management. ANH was performed in group A animals by, removing 5.8-6.6 mL of blood and replacing it with 3 times as much crystalloid. All rats were enthanized on postoperative day 6, and histopathologic analyses were performed.
RESULTS
The mean hematocrit values, after hemodilution were 22.0% (range, 18.0%-29.0%), group A; 33.0% (29.0%-35.0%), group N; and 32.5% (29.0%-34.0%), group C. There were significant differences between groups A and N (P = 0.019, P = 0.009, P = 0.004, P = 0.039, and P = 0.027), and between groups N and C (P = 0.006, P = 0.027, P = 0.04, P = 0.008, and P = 0.009) with respect to inflammatory cell numbers, neovascularization, fibroblast numbers, edema and necrosis, respectively; there were no differences between groups A and N.
CONCLUSION
In rat model, anastomotic complications did not increase in the ANH group, compared with the standard intraoperative management group.

Keyword

Hemodilution; Anastomotic leak; Experimental animal model

MeSH Terms

Anastomotic Leak
Animals
Blood Transfusion
Cell Count
Edema
Fibroblasts
Hematocrit
Hemodilution*
Methods
Models, Animal
Necrosis
Prospective Studies
Rats*
Rats, Sprague-Dawley

Figure

• 

  Fig. 1 Histopathological features of each groups. Mucosal epithelium was absent in anastomosis site (A and C, ×20) and dense (severe) neutrophilic infiltration with focal abscess formation, moderate fibroblast proliferation, and moderate neo-angiogenesis (B and D, ×200) were identified in group A (A and B) and group N (C and D). No anastomosis site and inflammatory reaction were identified in stomach specimen in group C (E, ×20; F, ×40). Group A, surgery with acute normovolemic hemodilution; group N, surgery with standard intraoperative management; group C, sham surgery with standard intraoperative management.

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