Contents lists available at ScienceDirect Biomedicine & Pharmacotherapy journal homepage: www.elsevier.com/locate/biopha Does the application of Ankaferd Blood Stopper rectally have positive effects on the healing of colorectal anastomosis and prevention of anastomotic leakage? An experimental study Serdar Kuru a, ⁎ , Kemal Kismet a , Yusuf Murat Bag a , Aziz Mutlu Barlas a , Mehmet Senes b , Murat Durak b , Nihat Yumusak c , Mustafa Kemal Urhan a , Turgut Cavusoglu a , Recep Pekcici a a Ankara Education and Research Hospital, Department of General Surgery, Ankara, Turkey b Ankara Education and Research Hospital, Department of Biochemistry, Ankara, Turkey c Harran University, Faculty of Veterinary Medicine, Department of Pathology, Sanliurfa, Turkey ARTICLE INFO Keywords: Ankaferd Blood Stopper Colorectal anastomosis Anastomotic healing Anastomotic leakage Rats Experimental ABSTRACT The purpose of this experimental study was to evaluate the potential effects on the healing of colorectal ana- stomoses of the rectal administration of Ankaferd Blood Stopper (ABS). Thirty Wistar-Albino male rats were randomly separated into 3 groups. In the sham group, only laparotomy and colonic mobilization was performed. In the other 2 groups, colon transection and anastomosis were carried out. Saline (2 mL, 0.9% NaCl) was given rectally via a feeding tube for 10 days after the surgical procedure in the sham and control groups. In Group 3 (ABS group), the rats were treated with rectally administered ABS (2 mL/day) for 10 days. In all groups, after the measurement of bursting pressures, tissue samples were collected for the measurement of tissue hydroxyproline and prolidase levels, and for histopathological evaluation on postoperative day 11. The rectal administration of ABS showed positive effects on bursting pressures, tissue prolidase and hydroxyproline levels, and the histo- pathological findings of colonic anastomosis. The rectal application of ABS had positive effects on the healing of colorectal anastomosis. As a natural product, it may be used effectively and safely to achieve better healing results after colorectal anastomosis. 1. Introduction Anastomotic leakage after colonic resection and primary anasto- mosis is a serious clinical problem for surgeons. Leakage of colorectal anastomosis can have catastrophic acute and long-term consequences, such as the need for more interventions, prolonged hospitalisation and higher morbidity and mortality rates [1]. The rates of colorectal ana- stomosis leakage vary between 6% and 30% depending on various risk factors and different anastomotic leak definitions [2]. Factors known to be associated with higher leakage rates are older age, diabetes mellitus, anemia, blood transfusions, previous radiation therapy, low anasto- moses in obese patients, intra-abdominal infection, level of anasto- mosis, malnutrition, weight loss, long operation times, intraperitoneal contamination, and alcohol intake [3]. Leakage following colectomy and primary anastomosis needs multiple procedures, and may result in intra-abdominal abscess formation, sepsis, and death [4]. Despite the developments in surgical technology, anastomotic leakage after color- ectal surgery still occurs at unacceptably high rates [5]. Although there have been many previous studies and research is ongoing, no definitive treatment for the prevention of anastomotic leaks has yet been identi- fied. Ankaferd Blood Stopper® (ABS) is a hemostatic agent, which has historically been used in Turkish traditional medicine. It is a unique folkloric medicinal plant extract [6]. ABS is composed of an en- capsulated protein network which provides attachment points for rapid erythrocyte aggregation. During this process, the physiological coagu- lation systems are not affected. ABS contains a standard mixture of plant extracts obtained from Thymus vulgaris, Alpinia officinarum, Vitis vinifera, Glycyrrhiza glabra, and Urtica dioica [7]. All of these herbs in- dividually are known to affect angiogenesis, endothelium, blood cells, vascular dynamics and cellular reproduction. They also stimulate the mediators that lead to the progression of wound healing [8]. Moreover, in a previous study the antimicrobial effect of ABS has been shown against 102 pathogens [9]. In the light of the knowledge of these beneficial effects on wound healing, this study was planned to investigate the possible effects of the rectal administration of ABS on the colorectal anastomotic healing in a rat model. https://doi.org/10.1016/j.biopha.2017.11.140 Received 26 October 2017; Received in revised form 21 November 2017; Accepted 27 November 2017 ⁎ Corresponding author at: S.B. Ankara Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği, Şükriye Mh, Ulucanlar Cd, No: 89, Altındağ, Ankara, 06230, Turkey. E-mail address: dokserkur@yahoo.com.tr (S. Kuru). Biomedicine & Pharmacotherapy xxx (xxxx) xxx–xxx 0753-3322/ © 2017 Elsevier Masson SAS. All rights reserved. Please cite this article as: Kuru, S., Biomedicine & Pharmacotherapy (2017), https://doi.org/10.1016/j.biopha.2017.11.140