BACKGROUND AND AIMS: High-dose glucocorticoid treatment has been identified as a risk factor for anastomotic leakage in patients with inflammatory bowel disease (IBD) undergoing bowel resection surgery. On the contrary, active disease during surgery is also associated with elevated morbidity. Perioperative low-dose treatment might be beneficial regarding postoperative outcomes by controlling disease activity. The present study is the first to investigate the dose-dependent effect of perioperative prednisolone therapy in a murine IBD model combining dextran-sodium sulfate (DSS) colitis with intestinal anastomosis surgery.

METHODS: In 84 ten-week-old wild-type mice a colorectal anastomosis was performed using microsurgical technique. Half the animals received induction of chemical colitis with 2% DSS via drinking water prior to surgery. In both groups, one third of the animals received daily oral administration of high-dose (0.533 mg/kg) and one third low-dose (0.133 mg/kg) prednisolone. Evaluation was performed on postoperative day 3 and 7.

RESULTS: While high-dose prednisolone treatment led to an increased anastomotic leakage rate in mice under colitis, low-dose prednisolone treatment limited preoperative disease activity and did not influence the leakage rate. Histologic examination showed a beneficial effect of low-dose prednisolone treatment on microscopic abscess formation at the anastomotic site in DSS mice as well as an increased anastomotic healing score.

CONCLUSIONS: We could demonstrate a beneficial effect of perioperative short-term low-dose prednisolone treatment on intestinal anastomotic healing in the context of colitis. Perioperative use of short-term low-dose prednisolone treatment might be beneficial in IBD patients that need to undergo surgery during active disease.