Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Impact of the negative endoluminal pressure on gastric healing: an in vivo study.
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Tustumi Francisco, Galvão Flávio Henrique Ferreira, Nakamura Eric Toshiyuki, Pereira Marina Alessandra, Cardili Leonardo, Alves Venancio Avancini Ferreira, Junior Ulysses Ribeiro
Аннотация
BACKGROUND: The biological effects of vacuum therapy on gastrointestinal healing remain poorly understood. This work aims to evaluate the effects of negative endoluminal pressure on gastric healing.
METHODS: 34 Wistar rats underwent gastric incision and were allocated into four groups: Group 1 (n = 10), incision only; Group 2 (n = 10), incision plus gastrostomy without vacuum; Group 3 (n = 7), incision plus vacuum therapy at -100 mmHg; and Group 4 (n = 7), at -300 mmHg. Animals remained restrained for 48 hours before euthanasia. Macroscopic and histopathological outcomes-gastritis, hemorrhage, adhesions, leak, mucosal erosion, fibrosis, and angiogenesis-were assessed using semi-quantitative scores. A composite healing score was calculated by summing fibrosis and angiogenesis and subtracting necrosis and hemorrhage.
RESULTS: Fibrosis in incisions was higher in the vacuum groups (Groups I/II/III/IV: 80/60/100/100%; P = .016). The necrosis rate was lower in Groups III and IV (Groups I/II/III/IV: 80/100/42.9/28.6%; P = .006). However, Groups III and IV were associated with a higher risk for moderate/severe gastritis (Groups I/II/III/IV: 10/0/100/100%; P < .001) and mucosal erosion (Groups I/II/III/IV: 0/0/100/85.7%; P < .001). The gastritis was more intense in Group IV than in Group III (P < .001). No significant differences were found for adhesions and angiogenesis (P > .05). The overall healing score was higher for Groups III and IV (median score for Groups I/II/III/IV: 0.5/2/3/4; P = .019), and this score did not differ between Groups III and IV (P = .502).
CONCLUSION: Vacuum therapy acts on the initial phases of the healing process, reducing necrosis and increasing fibrosis. Intense negative pressure is associated with severe gastritis and mucosal erosion.
METHODS: 34 Wistar rats underwent gastric incision and were allocated into four groups: Group 1 (n = 10), incision only; Group 2 (n = 10), incision plus gastrostomy without vacuum; Group 3 (n = 7), incision plus vacuum therapy at -100 mmHg; and Group 4 (n = 7), at -300 mmHg. Animals remained restrained for 48 hours before euthanasia. Macroscopic and histopathological outcomes-gastritis, hemorrhage, adhesions, leak, mucosal erosion, fibrosis, and angiogenesis-were assessed using semi-quantitative scores. A composite healing score was calculated by summing fibrosis and angiogenesis and subtracting necrosis and hemorrhage.
RESULTS: Fibrosis in incisions was higher in the vacuum groups (Groups I/II/III/IV: 80/60/100/100%; P = .016). The necrosis rate was lower in Groups III and IV (Groups I/II/III/IV: 80/100/42.9/28.6%; P = .006). However, Groups III and IV were associated with a higher risk for moderate/severe gastritis (Groups I/II/III/IV: 10/0/100/100%; P < .001) and mucosal erosion (Groups I/II/III/IV: 0/0/100/85.7%; P < .001). The gastritis was more intense in Group IV than in Group III (P < .001). No significant differences were found for adhesions and angiogenesis (P > .05). The overall healing score was higher for Groups III and IV (median score for Groups I/II/III/IV: 0.5/2/3/4; P = .019), and this score did not differ between Groups III and IV (P = .502).
CONCLUSION: Vacuum therapy acts on the initial phases of the healing process, reducing necrosis and increasing fibrosis. Intense negative pressure is associated with severe gastritis and mucosal erosion.