Sildenafil citrate improves microvascular density and healing in remnant gastric tissue after sleeve gastrectomy- An experimental study

Purpose: Obesity is a chronic, systemic, and multifactorial disease characterized by high morbidity rates. Sleeve gastrectomy (SG), one of the most frequently performed bariatric procedures, is a restrictive surgery where approximately 80% of the stomach is resected. Anastomotic leakage is one of the most fatal complications of this procedure, where tissue perfusion and healing play a critical role in prevention. This study aims to evaluate the effects of sildenafil citrate (SC), a phosphodiesterase type 5 (PDE-5) inhibitor, on microcirculation and oxidative stress parameters in the remnant gastric tissue following surgery.Method: Twenty male Wistar albino rats were randomly divided into two groups: Control (SG) (n=10) and Experimental (SG+SC) (n=10). The control group received oral saline, while the experimental group was administered 10 mg/kg/day of sildenafil citrate for five days. On the fifth day, the rats underwent gastrectomy, and the remnant gastric tissues were analyzed biochemically and histopathologically. To evaluate oxidative stress, levels of nitric oxide (NO), malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), total antioxidant capacity (TAC), total oxidant status (TOS), and glutathione (GSH) were measured using ELISA kits.Findings: Sildenafil citrate treatment led to a significant decrease in TOS, oxidative stress index (OSI), and MDA levels compared to the control group. Conversely, a significant increase was observed in the antioxidant markers CAT, GSH, and SOD. Histopathological examinations revealed lower levels of vascular dilatation, edema, and inflammation in the SC group, while microvascular density (Anti-CD34 positivity) was significantly higher.Conclusion: Sildenafil citrate contributes to tissue repair by suppressing oxidative damage and improving angiogenesis and microcirculatory hemodynamics in the operated gastric tissue. These findings suggest that SC may serve as a potential therapeutic agent in maintaining tissue integrity and reducing the risk of leakage complications following bariatric surgery.