Sildenafil sitrat, tüp mide ameliyatı sonrası remnant mide dokusunda mikrovasküler yoğunluğu ve iyileşmeyi artırır - Deneysel bir çalışma

Abstract

Amaç: Obezite, morbidite oranı yüksek, sistemik ve çok faktörlü kronik bir hastalıktır. Günümüzde en sık uygulanan bariatrik cerrahi yöntemlerinden biri olan tüp mide ameliyatı (sleeve gastrektomi - SG), midenin yaklaşık %80’inin rezeke edildiği kısıtlayıcı bir prosedürdür. Bu cerrahinin en mortal seyreden komplikasyonlarından biri olan anastomoz kaçağını önlemede doku perfüzyonu ve iyileşmesi kritik rol oynar. Bu çalışma, bir fosfodiesteraz tip 5 (PDE-5) inhibitörü olan sildenafil sitratın (SC), cerrahi sonrası mide kalıntı dokusundaki mikrosirkülasyon ve oksidatif stres parametreleri üzerindeki etkilerini değerlendirmeyi amaçlamıştır. Metod: Çalışmada 20 adet erkek Wistar albino sıçan; Kontrol (SG) (n=10) ve Deney (SG+SC) (n=10) olmak üzere iki gruba ayrıldı. Kontrol grubuna oral serum fizyolojik, deney grubuna ise 5 gün boyunca 10 mg/kg/gün sildenafil sitrat uygulandı. Beşinci günde gastrektomi uygulanan deneklerin remnant mide dokuları biyokimyasal ve histopatolojik açıdan incelendi. Oksidatif stres değerlendirmesi için nitrik oksit (NO), malondialdehit (MDA), katalaz (CAT), süperoksit dismutaz (SOD), toplam antioksidan kapasite (TAC), toplam oksidan durumu (TOS) ve glutatyon (GSH) seviyeleri ELISA yöntemiyle ölçüldü. Bulgular: Sildenafil sitrat tedavisi, kontrol grubuna kıyasla TOS, oksidatif stres indeksi (OSI) ve MDA seviyelerinde anlamlı bir azalma sağladı. Buna karşılık antioksidan göstergelerden CAT, GSH ve SOD seviyelerinde anlamlı artış saptandı. Histopatolojik incelemelerde, SC grubunda vasküler dilatasyon, ödem ve inflamasyonun daha düşük olduğu, mikrovasküler yoğunluğun (Anti-CD34 pozitifliği) ise anlamlı derecede arttığı belirlendi. Sonuç: Sildenafil sitrat, cerrahi uygulanan mide dokusunda oksidatif hasarı baskılayıp anjiyogenezi ve mikrosirkülasyon hemodinamiğini iyileştirerek doku onarımına katkı sağlamaktadır. Bu bulgular, SC'nin bariatrik cerrahi sonrası doku bütünlüğünü korumada ve olası kaçak komplikasyonlarını azaltmada potansiyel bir terapötik ajan olabileceğini göstermektedir.

Keywords

• sleeve gastrektomi
• morbid obezite
• bariatrik cerrahi
• sildenafil sitrat

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

Abstract

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.

Keywords

• sleeve gastrectomy
• morbid obesity
• bariatric surgery
• sildenafil citrate

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