Short cycles of remote ischemic preconditioning had no effect on tensile strength in small intestinal anastomoses: an experimental animal study

The aim of this study was to investigate the effect of remote ischemic preconditioning (RIPC) on the healing of small intestinal anastomoses, evaluated by tensile strength and histological wound healing on postoperative day five. Twenty-two female pigs were randomised 1:1 into either an intervention or control group. The intervention group received five cycles of 3 min ischemia followed by 3 min reperfusion on the right forelimb. Two end-to-end anastomoses, a distal and a proximal, were created in the small intestine 30 and 60 min after RIPC respectively. On postoperative day five, the anastomoses were harvested and underwent a maximal anastomotic tensile strength test (MATS 1-3) followed by histological analyses. MATS 1, when a tear became visible in the serosa, was significantly increased in the proximal anastomoses of the RIPC group compared to the control group (4.91 N vs. 3.83 N, p = 0.005). No other significant differences were found when comparing these two groups. In conclusion, our study showed no convincing results of RIPC on intestinal anastomotic healing to recommend its use in a general clinical setting. Further animal studies on RIPC’s effect after relative or absolute intestinal ischemia may be recommended.