Effect of Ozone Therapy (OT) on Healing of Colonic Anastomosis in a Rat Model of Peritonitis

Colonic resection and anastomosis is one of the most common operations in gastrointestinal surgery, both in children and adults.Although these are safe operations, an anastomosis leakage is a frequent problem (1, 2).Age, condition of the patient, colonic flora, inflammation and surgical techniques are the most important factors affecting the outcome of these procedures (3, 4).The presence of peritonitis is a defining factor of anastomosis integrity.The cecal ligation and puncture (CLP) model was first defined by Hubbard et al. (5) in 1978 to induce peritonitis.Several studies suggest that in the presence of peritonitis, wound healing worsens and anastomotic leakage increases.To avoid these unwanted effects of peritonitis on wound healing and to increase anastomosis security, various methods and local or systemic agents are being investigated.Ozone is a three-oxygen molecule (O 3 ).Ozone therapy (OT) is systematically effective when pathological inflammatory and immunologic processes are activated.Among these conditions are wound healing, macular degeneration related to aging, and conditions that are ischemic or infectious.During OT, the gaseous mixture of oxygen and ozone exerts biological actions that may increase certain enzymes and cytokines.Ozone provides its protective effects via autacoids, cytokines, and growth factors.Recurrent OT corrects the dis-Background: Ozone is a three-oxygen molecule (O3).Ozone therapy (OT) is systematically effective when pathological inflammatory and immunologic processes are activated.Among of these conditions are wound healing, macular degeneration related to aging, and conditions that are ischemic or infectious.Aims: The aim of this study was to determine the effects of OT on wound healing of intestinal anastomosis in the presence of peritonitis in a rat model. Study Design: Animal experimentation.Methods: A total of 40 Wistar albino rats were randomized into four groups (n=10) including: sham (S), peritonitis (P), ozone 0 (O0), and ozone 24 (O24).In group S, only cecal dissection was carried out.The S group had only a cecal dissection and intestinal anastomosis performed, but no peritonitis.In all other groups, cecal ligation and puncture (CLP) followed the cecal dissection to induce bacterial peritonitis.24 h after puncture, a cecal resection and ileocolic anastomosis were performed.In group P, 24 h after CLP, a cecal resection and ileocolic anastomosis were performed and no ozone was administered.In group O0, immediately after the anastomosis, and in group O24, starting 24 hours after the anastomosis, an intraperitoneal 1 mg/ kg/day ozone administration was applied for seven days.On the sev-enth day the animals were sacrificed, the anastomotic bursting pressures (BP) and the hydroxyproline values of the anastomotic tissues were measured, and histopathologic examination of the anastomotic segment was carried out.Results: The highest BP was in group S, with 211±23.13mmHg.The mean BP of group P was 141±56.25 mmHg, which was significantly lower than in the other two peritonitis groups that received ozone therapy, group O0 and O24, where it was 192±22 and 166±45 mmHg, respectively (p<0.05).The difference in the BP between groups O0 and O24 was not statistically significant (p>0.05).Histopathologic analyses of the anastomotic segments determined there was significantly more oedema and necrosis in the control group rats, and collagen deposition in the anastomotic tissue was significantly higher in the ozone-treated groups on postoperative day 7. Hydroxyproline levels were significantly higher in groups O0 and O24 compared to the peritonitis group (P).Conclusion: Ozone therapy has a beneficial effect on anastomotic healing of the colon in the presence of peritonitis.