Influence of Adalimumab Treatment on Anastomotic Strength, Degree of Inflammation, and Collagen Formation: An Experimental Study on the Small Intestine of Rabbits

Background: Adalimumab is a TNF-alpha inhibitor, which has gained wide use in the treatment of inflammatory bowel diseases. The potential detrimental effect of TNF-alpha inhibitors on postoperative complications such as anastomotic leakage is unknown. The aim of this study was to investigate the effect of a single therapeutic dose of adalimumab on anastomotic strength inflammation and collagen formation. Methods: Twenty-eight female rabbits (1.8-2.2 kg) were allocated to subcutaneous injection with either adalimumab (1.5 mg/ kg) (n=14) or placebo (n=14). One week after medication two separate end-to-end anastomoses were performed in the jejunum. The rabbits were killed on the third postoperative day. The anastomosis were subjected to tensile strength analysis and histopathological examination. Results: No statistically significant differences were found between the two groups regarding maximum tensile strength, inflammation parameters and collagen formation in the anastomosis area. Multiple regression analysis showed no association between maximum tensile strength histological changes, time under anaesthesia, duration of surgery, weight gain, weight loss and number of sutures in either group. Conclusion: We found no statistically significant effect of a single therapeutic dose of adalimumab on anastomotic strength, histological parameters or collagen formation in rabbits. (Inflamm Bowel Dis 2013;19:254-258)