Journal of Investigative Surgery, Early Online, 1–6, 2013 Copyright C  2013 Informa Healthcare USA, Inc. ISSN: 0894-1939 print / 1521-0553 online DOI: 10.3109/08941939.2013.826308 ORIGINAL ARTICLE Effects of Ankaferd on Anastomotic Healing of Colon Gulden Cancan, 1 Serkan Teksoz, 1 Erman Aytac, 1 Akif Enes Arikan, 1 Hayriye Erman, 2 Haize Uzun, 2 Ferhat Ozden, 3 Ovgu Aydin, 3 Murat Ozcan 1 1 Department of General Surgery, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey, 2 Department of Biochemistry, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey, 3 Department of Pathology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey ABSTRACT Background: Ankaferd (Ankaferd blood stopper R  , ABS) is a recently developed topical hemostatic agent. ABS is a standardized mixture of the plants Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia oficinarum, and Urtica dioica. Through its effects on the endothelium, blood cells, angiogenesis, cellular proliferation, vascular dynamics, and cell mediators; Ankaferd plays a part in inlammation and hemostasis processes. The aim of this experimental study is to assess the effects of ABS on the left colonic anastomoses under normal, septic, and ischemic conditions. Methods: Forty-eight Wistar Albino male rats were divided into six weight-matched equal groups: A, anastomosis in normal condition (n = 8); AA, anastomosis with ABS in normal condition (n = 8); AS, anastomosis in septic condition (n = 8); AAS, anastomosis with ABS in septic condition (n = 8); AI, anastomosis in ischemic condition (n = 8); and AAI, anastomosis with ABS in ischemic condition (n = 8). Blood and tissue samples were taken for the histopathological and biochemical studies after the anastomotic bursting pressures were measured. Re- sults: Higher hydroxyproline levels (p = .048) and angiogenesis (p = .038) were observed in the sepsis-induced rats compared to the control group. The inlammatory activity, ibrosis, and granulation were comparable in all experimental groups. Ankaferd improved the angiogenesis under septic conditions (AAS) when compared to the control group (AI; p = .038). Conclusions: ABS may support anastomotic healing in septic conditions. Topical ABS application controlling the mucosal bleeding at the cut ends of the colon may also improve the anastomotic wound healing by means of increasing mechanical strength and positively affecting angiogenesis. Further studies shall focus on the clinical importance of those indings. Keywords: ankaferd; colon anastomosis; anastomotic healing INTRODUCTION Ankaferd (Ankaferd blood stopper R  , ABS) is a re- cently developed topical hemostatic agent. ABS is a standardized mixture of the plants Thymus vulgaris, Glycyrrhiza glabra, Vitis vinifera, Alpinia oficinarum, and Urtica dioica. Through its effects on the endothelium, blood cells, angiogenesis, cellular proliferation, vas- cular dynamics, and cell mediators; Ankaferd plays a part in inlammation and hemostasis processes. While the ingredients of ABS were used to stop bleeding in ancient folkloric Turkish Medicine [1, 2], it was about to be forgotten during the development of the modern medicine in Turkey. In late 2000s, Turkish physicians standardized ABS as a modern hemostatic agent by Received 2 March 2013; accepted 15 July 2013. Address correspondence to Gulden Cancan, MD, Department of General Surgery, Cerrahpasa Medical School, Istanbul University, 34098 Fatih, Istanbul, Turkey. E-mail: drguldenpolat@yahoo.co.uk presenting its pharmacodynamics and molecular mechanisms [1, 3, 4]. ABS is shown to have hemostatic and regenerative proliferation effects in in vivo and in vitro studies [5, 6]. ABS stimulates the construction of a protein network with an alternative pathway via affecting cellular mechanisms [5]. ABS-induced formation of the protein network with vital erythroid aggregation covers the entire physiological hemostatic process [2]. Anastomotic leakage is one of the major com- plications of intestinal surgery. Failure of intestinal anastomosis increases postoperative morbidity and mortality [7]. In the literature, the rate of anastomosis leakage is given as 3.4%–12% [8]. One-third of the postoperative morbidities in the patient undergoing 1 J Invest Surg Downloaded from staging.informahealthcare.com by Simone Skeen on 08/29/13 For personal use only.