Skip to main content
Erschienen in: European Surgery 4/2020

03.04.2019 | original article

Histologic changes in early colonic anastomotic healing using autologous platelet-rich fibrin matrix

verfasst von: Bernhard Dauser, MD FEBS, Wolf Heitland, MD, Franz G. Bader, MD, Walter Brunner, MSc FRCS, Yael Nir, MD, Andrew P. Zbar, MD (Lond) MBBS (Melb) FRCS (Ed) FRACS FSICCR (Hon)

Erschienen in: European Surgery | Ausgabe 4/2020

Einloggen, um Zugang zu erhalten

Summary

Background

Anastomotic leakage represents a devastating post-surgical event with surgeon- and patient-related causes. The early lag phase of healing (day 0–4) is a time of increased vulnerability. The current role of tissue sealants as anastomotic adjuncts remains unclear, with controversial results reported. Platelet-rich plasma provides a reliable source of growth factors supporting wound healing. We aimed to assess the impact of a novel autologous platelet-rich fibrin (PRF) agent (Obsidian-ASG® matrix; GergMed Medizintechnik, Baiern, Germany) on colonic anastomotic healing in a porcine model.

Methods

Left-sided colonic anastomoses were constructed in 16 pigs with reinforcement using the Obsidian-ASG® matrix in 12 animals. Animals were sacrificed on days 0, 4, 10 and 30, with histologic assessment of the anastomotic line along with evaluation of fibrotic tissue maturation, foreign body reactivity and mucin production. Collagen maturity and immunohistochemical changes of angiogenesis and infiltrating macrophage profiles were determined as well.

Results

There was no observable effect in matrix-treated animals on epithelial line thickness, granulation tissue formation, foreign body reactivity or mucosal restitution. Matrix-treated animals showed higher mucin production on day 4 accompanied by a more mature collagen and a greater degree of early angiogenic response with a higher infiltration density of M2 macrophages. Additionally, anastomotic burst pressure in matrix-treated animals was higher on day 0, 4, 10 and 30 (100, 100, 210, 160 vs. 40, 30, 60, 20 mm Hg, respectively).

Conclusion

Obsidian-ASG® matrix may have beneficial effects on anastomotic healing by shifting the inflammatory response towards a mature and more stable collagen phenotype in the early phase.
Literatur
1.
Zurück zum Zitat Buchs NC, Gervaz P, Secic M, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2008;23:265–70.CrossRef Buchs NC, Gervaz P, Secic M, Mugnier-Konrad B, Morel P. Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study. Int J Colorectal Dis. 2008;23:265–70.CrossRef
2.
Zurück zum Zitat McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102:462–79.CrossRef McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102:462–79.CrossRef
3.
Zurück zum Zitat Berho M, Wexner SD, Botero-Anug A‑M, Pelled D, Fleshman JW. Histopathologic advantages of compression ring anastomosis healing as compared with stapled anastomosis in a porcine model: a blinded comparative study. Dis Colon Rectum. 2014;57:506–13.CrossRef Berho M, Wexner SD, Botero-Anug A‑M, Pelled D, Fleshman JW. Histopathologic advantages of compression ring anastomosis healing as compared with stapled anastomosis in a porcine model: a blinded comparative study. Dis Colon Rectum. 2014;57:506–13.CrossRef
4.
Zurück zum Zitat Pommergaard H‑C, Achiam MP, Rosenberg J. External coating of colonic anastomoses: a systematic review. Int J Colorectal Dis. 2012;27:1247–58.CrossRef Pommergaard H‑C, Achiam MP, Rosenberg J. External coating of colonic anastomoses: a systematic review. Int J Colorectal Dis. 2012;27:1247–58.CrossRef
5.
Zurück zum Zitat Vakalopoulos KA, Daams F, Wu Z, et al. Tissue adhesives in gastrointestinal anastomosis: a systematic review. J Surg Res. 2013;180:290–300.CrossRef Vakalopoulos KA, Daams F, Wu Z, et al. Tissue adhesives in gastrointestinal anastomosis: a systematic review. J Surg Res. 2013;180:290–300.CrossRef
6.
Zurück zum Zitat Stergios K, Kontzoglou K, Pergialiotis V, Korou LM, Frountzas M, Lalude O, Nikiteas N. The potential effect of biological sealants on colorectal anastomosis: healing in experimental research involving severe diabetes. Ann R Coll Surg Engl. 2017;99:189–92.CrossRef Stergios K, Kontzoglou K, Pergialiotis V, Korou LM, Frountzas M, Lalude O, Nikiteas N. The potential effect of biological sealants on colorectal anastomosis: healing in experimental research involving severe diabetes. Ann R Coll Surg Engl. 2017;99:189–92.CrossRef
7.
Zurück zum Zitat Vakalopulos KA, Wu Z, Kroese LF, Jeekel J, Kleinrinsenk G‑J, Dodou D, Lam KH, Lange JF. Sutureless closure of colonic defects with tissue adhesives: an in vivo study. Am J Surg. 2017;213:151–8.CrossRef Vakalopulos KA, Wu Z, Kroese LF, Jeekel J, Kleinrinsenk G‑J, Dodou D, Lam KH, Lange JF. Sutureless closure of colonic defects with tissue adhesives: an in vivo study. Am J Surg. 2017;213:151–8.CrossRef
8.
Zurück zum Zitat Akgün A, Kuru S, Uraldi C, Tekin O, Karip B, Tug T, Ongoren AU. Early effects of fibrin sealant on colonic anastomosis in rats: an experimental and case-control study. Tech Coloproctol. 2006;10:208–14.CrossRef Akgün A, Kuru S, Uraldi C, Tekin O, Karip B, Tug T, Ongoren AU. Early effects of fibrin sealant on colonic anastomosis in rats: an experimental and case-control study. Tech Coloproctol. 2006;10:208–14.CrossRef
9.
Zurück zum Zitat Giuratrabocchetta S, Rinaldi M, Cuccia F, Lemma M, Piscitelli D, Polidoro P, Altomare DF. Protection of intestinal anastomosis with biological glues: an experimental method. Tech Coloproctol. 2011;15:153–8.CrossRef Giuratrabocchetta S, Rinaldi M, Cuccia F, Lemma M, Piscitelli D, Polidoro P, Altomare DF. Protection of intestinal anastomosis with biological glues: an experimental method. Tech Coloproctol. 2011;15:153–8.CrossRef
10.
Zurück zum Zitat Vakalopoulos KA, Wu Z, Kroese LF, van der Horst PH, Lam KH, Dodou D, Jeekel JJ, Lange JF. Clinical, mechanical, and immunohistopathological effects of tissue adhesives on the colon: an in‐vivo study. J Biomed Mater Res Part B Appl Biomater. 2017;105(4):846–54.CrossRef Vakalopoulos KA, Wu Z, Kroese LF, van der Horst PH, Lam KH, Dodou D, Jeekel JJ, Lange JF. Clinical, mechanical, and immunohistopathological effects of tissue adhesives on the colon: an in‐vivo study. J Biomed Mater Res Part B Appl Biomater. 2017;105(4):846–54.CrossRef
11.
Zurück zum Zitat Nordentoft T. Sealing of gastrointestinal anastomoses with fibrin glue coated collagen patch. Dan Med J. 2015;62(5):B5081.PubMed Nordentoft T. Sealing of gastrointestinal anastomoses with fibrin glue coated collagen patch. Dan Med J. 2015;62(5):B5081.PubMed
12.
Zurück zum Zitat Huh JW, Kim HR, Kim YJ. Anastomotic leakage after laparoscopic resection of rectal cancer: the impact of fibrin glue. Am J Surg. 2010;199:435–41.CrossRef Huh JW, Kim HR, Kim YJ. Anastomotic leakage after laparoscopic resection of rectal cancer: the impact of fibrin glue. Am J Surg. 2010;199:435–41.CrossRef
13.
Zurück zum Zitat Spotnitz WD. Fibrin sealant: Past, present and future: a brief review. World J Surg. 2010;34:632–4.CrossRef Spotnitz WD. Fibrin sealant: Past, present and future: a brief review. World J Surg. 2010;34:632–4.CrossRef
14.
Zurück zum Zitat Nanditha S, Chandrasekaran B, Muthusamy S, Muthu K. Apprising the diverse facets of platelet rich fibrin in surgery through a systematic review. Int J Surg. 2017;46:186–94.CrossRef Nanditha S, Chandrasekaran B, Muthusamy S, Muthu K. Apprising the diverse facets of platelet rich fibrin in surgery through a systematic review. Int J Surg. 2017;46:186–94.CrossRef
15.
Zurück zum Zitat Rughetti A, Giusti I, D’Ascenzo S, Leocata P, Carta G, Pavan A, Dell’Orso L, Dolo V. Platelet gel-released supernatant modulates the angiogenic capability of human endothelial cells. Blood Transfus. 2008;6:12–7.PubMedPubMedCentral Rughetti A, Giusti I, D’Ascenzo S, Leocata P, Carta G, Pavan A, Dell’Orso L, Dolo V. Platelet gel-released supernatant modulates the angiogenic capability of human endothelial cells. Blood Transfus. 2008;6:12–7.PubMedPubMedCentral
16.
Zurück zum Zitat Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun’s platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009;27:63–9.CrossRef Dohan Ehrenfest DM, de Peppo GM, Doglioli P, Sammartino G. Slow release of growth factors and thrombospondin-1 in Choukroun’s platelet-rich fibrin (PRF): a gold standard to achieve for all surgical platelet concentrates technologies. Growth Factors. 2009;27:63–9.CrossRef
17.
Zurück zum Zitat Bai MY, Wang CW, Wang JY, Lin MF, Chan WP. Three-dimensional structure and cytokine distribution of platelet-rich fibrin. Clinics (Sao Paulo). 2017;72:116–24.CrossRef Bai MY, Wang CW, Wang JY, Lin MF, Chan WP. Three-dimensional structure and cytokine distribution of platelet-rich fibrin. Clinics (Sao Paulo). 2017;72:116–24.CrossRef
18.
Zurück zum Zitat Kjaergard HK, Fairbrother JE, Cederholm-Williams SA, Edwardson PAD, Hollingsbee DA, Holm NE. The Vivostat system for the automated preparation of autologous fibrin sealant. Cardiovasc Eng. 1997;2:204–6. Kjaergard HK, Fairbrother JE, Cederholm-Williams SA, Edwardson PAD, Hollingsbee DA, Holm NE. The Vivostat system for the automated preparation of autologous fibrin sealant. Cardiovasc Eng. 1997;2:204–6.
19.
Zurück zum Zitat Velada JL, Hollingsbee DA, Menzies AR, Cornwell R, Dodd RA. Reproducibility of the mechanical properties of Vivostat patient-derived fibrin sealant. Biomaterials. 2002;23:2249–54.CrossRef Velada JL, Hollingsbee DA, Menzies AR, Cornwell R, Dodd RA. Reproducibility of the mechanical properties of Vivostat patient-derived fibrin sealant. Biomaterials. 2002;23:2249–54.CrossRef
20.
Zurück zum Zitat Kilkenny C, Browne W, Cuthill IC, et al. Animal research: Reporting in vivo experiments: the ARRIVE guidelines. Br J Pharmacol. 2010;160:1577–9.CrossRef Kilkenny C, Browne W, Cuthill IC, et al. Animal research: Reporting in vivo experiments: the ARRIVE guidelines. Br J Pharmacol. 2010;160:1577–9.CrossRef
21.
Zurück zum Zitat Dodd RA, Cornwell R, Holm NE, Garbasch A, Hollingsbee DA. The Vivostat application system: a comparison with conventional fibrin sealant systems. Technol Health Care. 2002;10(5):401–11.CrossRef Dodd RA, Cornwell R, Holm NE, Garbasch A, Hollingsbee DA. The Vivostat application system: a comparison with conventional fibrin sealant systems. Technol Health Care. 2002;10(5):401–11.CrossRef
22.
Zurück zum Zitat Kjaergard HK, Velada JL, Pedesen JH, Fleron H, Hollingsbee DA. Comparative kinetics of polymerization of three sealants and influence on timing of tissue adhesion. Thromb Res. 2000;98:221–8.CrossRef Kjaergard HK, Velada JL, Pedesen JH, Fleron H, Hollingsbee DA. Comparative kinetics of polymerization of three sealants and influence on timing of tissue adhesion. Thromb Res. 2000;98:221–8.CrossRef
23.
Zurück zum Zitat Zuhlke HV, Lorenz EM, Straub EM, et al. Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl Ii Verh Dtsch Ges Chir. 1990;345:1009–16. Zuhlke HV, Lorenz EM, Straub EM, et al. Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl Ii Verh Dtsch Ges Chir. 1990;345:1009–16.
24.
Zurück zum Zitat Kopelman Y, Siersema PD, Nir Y, et al. Endoluminal compression clip: full-thickness resection of the mesenteric bowel wall in a porcine model. Gastrointest Endosc. 2009;70:1146–57.CrossRef Kopelman Y, Siersema PD, Nir Y, et al. Endoluminal compression clip: full-thickness resection of the mesenteric bowel wall in a porcine model. Gastrointest Endosc. 2009;70:1146–57.CrossRef
25.
Zurück zum Zitat Barros MH, Hauck F, Dreyer JH, Kempkes B, Niedobitek G. Macrophage polarization: an immunohistochemical approach for identifying M1 and M2 macrophages. PLoS ONE. 2013;8(11):e80908.CrossRef Barros MH, Hauck F, Dreyer JH, Kempkes B, Niedobitek G. Macrophage polarization: an immunohistochemical approach for identifying M1 and M2 macrophages. PLoS ONE. 2013;8(11):e80908.CrossRef
26.
Zurück zum Zitat Lundquist R, Dziegel MH, Agren MS. Bioactivity and stability of endogenous fibrogenic factors in platelet-rich fibrin. Wound Repair Regen. 2008;16:356–63.CrossRef Lundquist R, Dziegel MH, Agren MS. Bioactivity and stability of endogenous fibrogenic factors in platelet-rich fibrin. Wound Repair Regen. 2008;16:356–63.CrossRef
27.
Zurück zum Zitat Isobe K, Suzuki M, Watanabe T, Kitamura Y, Suzuki T, Kawabata H, Nakamura M, Okudera T, Okudera H, Uematsu K, et al. Platelet-rich fibrin prepared from stored whole-blood samples. Int J Implant Dent. 2017;3(1):6.CrossRef Isobe K, Suzuki M, Watanabe T, Kitamura Y, Suzuki T, Kawabata H, Nakamura M, Okudera T, Okudera H, Uematsu K, et al. Platelet-rich fibrin prepared from stored whole-blood samples. Int J Implant Dent. 2017;3(1):6.CrossRef
28.
Zurück zum Zitat O’Connell SM, Impeduglia T, Hessler K, Wang XJ, Carroll RJ, Dardik H. Autologous platelet rich fibrin matrix as cell therapy in the healing of chronic lower-extremity ulcers. Wound Repair Regen. 2017;16:749–56.CrossRef O’Connell SM, Impeduglia T, Hessler K, Wang XJ, Carroll RJ, Dardik H. Autologous platelet rich fibrin matrix as cell therapy in the healing of chronic lower-extremity ulcers. Wound Repair Regen. 2017;16:749–56.CrossRef
29.
Zurück zum Zitat Yu P, Zhai Z, Jin X, Yang X, Qi Z. Clinical application of platelet-rich fibrin in plastic and reconstructive surgery: a systematic review. Aesthetic Plast Surg. 2018;42:511–9.CrossRef Yu P, Zhai Z, Jin X, Yang X, Qi Z. Clinical application of platelet-rich fibrin in plastic and reconstructive surgery: a systematic review. Aesthetic Plast Surg. 2018;42:511–9.CrossRef
30.
Zurück zum Zitat Yamaguchi R, Terashima H, Yoneyama S, Tadano S, Ohkohchi N. Effects of platelet-rich plasma on intestinal anastomotic healing in rats: PRP concentration is a key factor. J Surg Res. 2012;173:258–66.CrossRef Yamaguchi R, Terashima H, Yoneyama S, Tadano S, Ohkohchi N. Effects of platelet-rich plasma on intestinal anastomotic healing in rats: PRP concentration is a key factor. J Surg Res. 2012;173:258–66.CrossRef
31.
Zurück zum Zitat Byrne DJ, Hardy J, Wood RA, McIntosh R, Hopwood D, Cuschieri A. Adverse influence of fibrin sealant on the healing of high-risk sutured colonic anastomoses. J R Coll Surg Edinb. 1992;37:394–8.PubMed Byrne DJ, Hardy J, Wood RA, McIntosh R, Hopwood D, Cuschieri A. Adverse influence of fibrin sealant on the healing of high-risk sutured colonic anastomoses. J R Coll Surg Edinb. 1992;37:394–8.PubMed
32.
Zurück zum Zitat Fresno L, Fondevila D, Banmbo O, Chacaltana A, Garcia F, Andaluz A. Effects of platelet-rich plasma on intestinal wound healing in pigs. Vet J. 2010;185:322–7.CrossRef Fresno L, Fondevila D, Banmbo O, Chacaltana A, Garcia F, Andaluz A. Effects of platelet-rich plasma on intestinal wound healing in pigs. Vet J. 2010;185:322–7.CrossRef
33.
Zurück zum Zitat Fajardo AD, Chun J, Stewart D, Safar B, Fleshman JW. 1.5:1 meshed AlloDerm bolsters for stapled rectal anastomoses does not provide any advantage in anastomotic strength in a porcine model. Surg Innov. 2011;18(1):21–8.CrossRef Fajardo AD, Chun J, Stewart D, Safar B, Fleshman JW. 1.5:1 meshed AlloDerm bolsters for stapled rectal anastomoses does not provide any advantage in anastomotic strength in a porcine model. Surg Innov. 2011;18(1):21–8.CrossRef
34.
Zurück zum Zitat Yol S, Tekin A, Yilmaz H, Kucukkartallar T, Esen H, Caglayan O, Tatkan Y. Effects of platelet rich plasma on colonic anastomosis. J Surg Res. 2008;146:190–4.CrossRef Yol S, Tekin A, Yilmaz H, Kucukkartallar T, Esen H, Caglayan O, Tatkan Y. Effects of platelet rich plasma on colonic anastomosis. J Surg Res. 2008;146:190–4.CrossRef
35.
Zurück zum Zitat Krarup P‑M, Eld M, Heiemeier K, Jorgensen LN, Hansen MB, Ågren MS. Expression and inhibition of matrix metalloproteinase (MMP)-8, MMP-9 and MMP-12 in early colonic anastomotic repair. Int J Colorectal Dis. 2013;28:1151–519.CrossRef Krarup P‑M, Eld M, Heiemeier K, Jorgensen LN, Hansen MB, Ågren MS. Expression and inhibition of matrix metalloproteinase (MMP)-8, MMP-9 and MMP-12 in early colonic anastomotic repair. Int J Colorectal Dis. 2013;28:1151–519.CrossRef
36.
Zurück zum Zitat Shogan BD, Smith DP, Christley S, Gilbert JA, Zaborina O, Alverdy JC. Intestinal anastomotic injury alters spatially defined microbiome composition and function. Microbiome. 2014;2:35.CrossRef Shogan BD, Smith DP, Christley S, Gilbert JA, Zaborina O, Alverdy JC. Intestinal anastomotic injury alters spatially defined microbiome composition and function. Microbiome. 2014;2:35.CrossRef
38.
Zurück zum Zitat Skowron KB, Shogan BD, Rubin DT, Hyman NH. The new frontier: the intestinal microbiome and surgery. J Gastrointest Surg. 2018;22:1277–85.CrossRef Skowron KB, Shogan BD, Rubin DT, Hyman NH. The new frontier: the intestinal microbiome and surgery. J Gastrointest Surg. 2018;22:1277–85.CrossRef
Metadaten
Titel
Histologic changes in early colonic anastomotic healing using autologous platelet-rich fibrin matrix
verfasst von
Bernhard Dauser, MD FEBS
Wolf Heitland, MD
Franz G. Bader, MD
Walter Brunner, MSc FRCS
Yael Nir, MD
Andrew P. Zbar, MD (Lond) MBBS (Melb) FRCS (Ed) FRACS FSICCR (Hon)
Publikationsdatum
03.04.2019
Verlag
Springer Vienna
Erschienen in
European Surgery / Ausgabe 4/2020
Print ISSN: 1682-8631
Elektronische ISSN: 1682-4016
DOI
https://doi.org/10.1007/s10353-019-0578-9

Weitere Artikel der Ausgabe 4/2020

European Surgery 4/2020 Zur Ausgabe