Effects of Platelet Rich Plasma on Colonic Anastomosis

doi:10.1016/j.jss.2007.05.015

Journal of Surgical Research

Volume 146, Issue 2, 15 May 2008, Pages 190-194

https://doi.org/10.1016/j.jss.2007.05.015 Get rights and content

Purpose

To investigate the effect of platelet-rich plasma (PRP) on tissue maturation and wound healing in experimental colonic anastomosis.

Materials and methods

Thirty Sprague Dawley rats were divided into three groups of 10 rats each. Group I (control group) was subjected to colon anastomosis only. Group II (PRP group) was subjected to colon anastomosis and topical PRP was applied. Group III (Bioglue group) was subjected to colon anastomosis and topical tissue sealant was applied (Bioglue; Cryolife, Kennesaw, GA). The rats were sacrificed on postoperative day 7, and the bursting pressure of the anastomosis and tissue hydroxyproline levels were measured; histopathological changes on the anastomosis line were also examined.

Results

The bursting pressure was statistically higher in the PRP group than in the control and Bioglue groups (P < 0.05). The hydroxyproline levels were also statistically higher in the PRP group than in the control and Bioglue groups (P < 0.05). Histopathologically, there was less inflammatory cell infiltration, intensive fibroblast development, and rich collagen production in the PRP group.

Conclusion

PRP may be used in colon anastomosis, especially in patients with impaired wound healing, to obtain a better anastomotic strength.

Introduction

Anastomotic dehiscence or failure is associated with increased morbidity and mortality in colorectal surgery [1]. The reported incidence of anastomotic leakage ranges from as low as 0% to as high as 35% [2]. Despite developments in suture techniques and materials, anastomotic leakage remains a problem. Many materials and methods have been used to prevent spontaneous perforation, septicemia, and an increased percentage of anastomotic dehiscence [3].

Platelet-rich plasma (PRP) is a new and potentially useful adjunct in oral and maxillofacial bone reconstructive surgery. Platelets are very important in the wound-healing process. They arrive quickly at the wound site and begin coagulation. They release multiple wound-healing growth factors and cytokines, including platelet-derived growth factor (PDGF), transforming growth factors (TGF-β1 and β2), vascular endothelial growth factor, platelet-derived endothelial cell growth factor, interleukin-1 (IL-1), basic fibroblast growth factor, and platelet activating factor-4.

PRP is produced from the centrifuge of autologous blood and then combined with thrombin and calcium chloride to produce a viscous coagulum gel capable of being introduced as a surgical graft material. Documented evidence demonstrates the release of a cascade of growth factors through the activation of the platelets with calcium chloride and thrombin [4].

Bioglue (Cryolife, Kennesaw, GA) is a surgical adhesive that combines two agents with distinct properties (45% concentrated bovine albumin and 10% glutaraldehyde) [5]. The sealing mechanism in unclear and may be related to a combination of the physical barrier created by the Bioglue and the facilitation of the tissue approximation. Bioglue, which makes a water-resistant cover, constitutes a physical barrier around the anastomoses. Bioglue sealant contributes to wound healing by improving angiogenesis, suitable media for fibroblast proliferation, and collagen production.

Surgeons aim to make a safe anastomosis and offer a more comfortable postoperative period with minimum doubt about the reliability of the anastomosis. Although positive effects of PRP on graft maturation and wound healing are well known, a similar effect on intestinal anastomosis has not been reported.

In this study, the positive effect of PRP and the use of the tissue adhesive Bioglue on tissue maturation and wound healing were investigated in experimental colonic anastomosis.

Section snippets

Materials and Methods

This study was established at the Experimental Research Center of Selçuk University with the permission of the Ethical Committee and was conducted in accordance with the International Standards for the Care and Use of Laboratory Animals. Thirty Sprague Dawley rats weighing 250 to 290 g (range: 270 ± 19 g) were used in this study, and were divided into three groups of 10 rats each, as follows:

Group I: Control group (n = 10), subjected to colon anastomosis only.
Group II: PRP group (n = 10),

Bursting Pressure of the Anastomosis

In the control group, the average bursting pressure of the anastomosis was found to be 195.5 ± 15.3 mmHg versus 270 ± 29.8 mmHg in the PRP group and 214 ± 16.46 mmHg in the Bioglue group. There was a statistically significant difference between the control group and the PRP group (P < 0.001). A similar statistically significant difference was found between the PRP and Bioglue groups (P < 0.001). When compared with the control group, the bursting pressure of the anastomosis was higher in the

Discussion

Anastomotic failure is associated with elevated rates of morbidity and mortality and continues to be a major clinical problem for the colorectal surgeon [9, 10]. Although there have been significant advances in preoperative preparation and surgical techniques, leakage of colonic anastomoses continues to be a significant cause of perioperative morbidity and mortality in patients undergoing colonic surgery [11]. There is a direct correlation between anastomotic failure and the mechanical

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GastrointestinalEffects of Platelet Rich Plasma on Colonic Anastomosis

Purpose

Materials and methods

Results

Conclusion

Introduction

Section snippets

Materials and Methods

Bursting Pressure of the Anastomosis

Discussion

Ann Thorac Surg

Arch Biochem Biophys

Am J Surg

J Surg Res

Surg Clin North Am

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Surg Clin North Am

Oral Surg Oral Med Oral Pathol, Oral Radiol Endod

Does becaplermin (platelet-derived growth factor-BB) reverse detrimental effects of ischemia on colonic anastomosis?

Dis Colon Rectum

Healing of experimental intestinal anastomosesParameters for repair

Dis Colon Rectum

Effect of fibrin glue on irradiated colonic anastomoses

Dis Colon Rectum

Gastrointestinal
Effects of Platelet Rich Plasma on Colonic Anastomosis