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Gené-Škrabec C, Cremades M, Fernández-Pujol A, Cortinovis S, Corral J, Julián JF, Parés D. Clinical results after external reinforcement of colorectal anastomosis: a systematic review. Int J Surg 2023; 109:4322-4332. [PMID: 37707516 PMCID: PMC10720808 DOI: 10.1097/js9.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of this review is to describe and assess the existing methods to cover colorectal anastomoses with biomaterials and their clinical impact in reducing anastomotic leakage (AL). SUMMARY BACKGROUND DATA The most serious complication in colorectal surgery is AL. Despite improvements in its diagnosis and management, AL remains an unresolved issue. To prevent its appearance and clinical consequences, different external reinforcement techniques with synthetic or biomaterials have been described. METHODS A systematic review search of the available literature until June 2022 was performed, looking for all literature regarding external reinforcement of colonic or colorectal anastomoses. After the review process, a classification of materials was proposed into solid and liquid materials, and an assessment of their clinical impact was performed. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA and AMSTAR Guidelines 11,12 . RESULTS Ninety-seven articles that fulfilled inclusion criteria, were identified and revised. Overall, 18 of the selected articles focused on human clinical trials and 79 on animal models. Only fibrin sealants, collagen patches, and omentoplasty have shown positive results in humans. CONCLUSIONS Fibrin sealants, collagen patches, and omentoplasty are, so far, the most studied biomaterials. However, further studies are required to confirm these findings before definite recommendations can be made.
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Affiliation(s)
- Clara Gené-Škrabec
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - Manel Cremades
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | | | - Sara Cortinovis
- Department of General Surgery, ASUGI Cattinara, Università degli studi di Trieste, Trieste, Italy
| | - Javier Corral
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - Joan-F Julián
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - David Parés
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
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Bello-López JM, López-Ornelas A, Vilchis-Rangel RE, Ribas-Aparicio RM, Del-Moral P, Donis-Rocandio JE, Cueto J, Aparicio-Ozores G, Moreno J. In vitro bactericidal activity of a carbohydrate polymer with zinc oxide for the treatment of chronic wounds. J Med Microbiol 2020; 69:874-880. [PMID: 32459619 DOI: 10.1099/jmm.0.001204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction. Biological adhesives and effective topical therapeutic agents that improve wound healing are urgently required for the treatment of chronic ulcers. A biodegradable adhesive based on a carbohydrate polymer with zinc oxide (CPZO) was shown to possess anti-inflammatory activity and enhance wound healing, but its bactericidal activity was unknown.Aim. To investigate the bactericidal activity of CPZO against bacteria commonly present as infectious agents in chronic wounds.Methodology. We examined the bactericidal activity of CPZO against three biofilm-producing bacteria (Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa) through three strategies: bacterial suspension, biofilm disruption and in vitro wound biofilm model.Results. In suspension cultures, CPZO had direct, potent bactericidal action against S. aureus within 24 h, whereas E. coli took 7 days to be eliminated. By contrast, P. aeruginosa survived up to 14 days with CPZO. CPZO had biofilm disruption activity against clinical isolates of S. aureus in the anti-biofilm test. Finally, in the in vitro wound biofilm model, CPZO dramatically reduced the bacterial viability of S. aureus and P. aeruginosa.Conclusions. Together with its previously shown anti-inflammatory properties, the bactericidal activity of CPZO gives it the potential to be a first-line therapeutic option for chronic various ulcers and, possibly, other chronic ulcers, preventing or controlling microbial infections, and leading to the healing of such complicated chronic ulcers.
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Affiliation(s)
| | | | - Rodolfo Erik Vilchis-Rangel
- Department of Microbiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Rosa María Ribas-Aparicio
- Department of Microbiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Pamela Del-Moral
- Health Sciences Faculty, Anahuac University, Estado de México, Mexico
| | - Jenny Elizabeth Donis-Rocandio
- Department of Microbiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Jorge Cueto
- Health Sciences Faculty, Anahuac University, Estado de México, Mexico
| | - Gerardo Aparicio-Ozores
- Department of Microbiology, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - José Moreno
- Direction of Research, Hospital Juárez de México, Cuidad de México, Mexico
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Moreno-Eutimio MA, Espinosa-Monroy L, Orozco-Amaro T, Torres-Ramos Y, Montoya-Estrada A, Jose Hicks J, Rodríguez-Ayala E, Moral PD, Moreno J, Cueto-García J. Enhanced healing and anti-inflammatory effects of a carbohydrate polymer with zinc oxide in patients with chronic venous leg ulcers: preliminary results. Arch Med Sci 2018; 14:336-344. [PMID: 29593807 PMCID: PMC5868658 DOI: 10.5114/aoms.2016.59851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 08/01/2015] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Insufficient wound healing related to chronic inflammation of chronic venous leg ulcers (CVUs) represents an important public health problem. The aim of this study was to evaluate the effects of a carbohydrate polymer with zinc oxide therapy on CVUs. MATERIAL AND METHODS Forty patients with CVUs were recruited for this study and were divided into a study group and control group. Patients In the study group were instructed to use venous compression treatment andtopical carbohydrate polymer with zinc oxide twice daily, while patients In the control group were treated with only venous compression treatment. All patients were followed up for 8 weeks. Peripheral blood samples and biosy tissue specimens were obtained at the initiation of treatment and after 8 weeks to assess serum levels of inflammatory cytokines as well as the percentage of leukocytes, T-helper cells, cytotoxic-T cells, macrophages and endothelial cells in the biopsy tissue using flow cytometry. RESULTS A significantly greater reduction in the mean percentage ulcer area from baseline to eight weeks was observed in the study group (up to 40% for large ulcers). Furthermore, the patients in the study group had reduced systemic levels of the pro-inflammatory cytokines IL-8 (p = 0.0028) and IL-6 (p = 0.0302), fewer total CD45+ cells (p = 0.0038) and more CD31+ cells (p = 0.045) present in ulcer biopsies compared to the control group. CONCLUSIONS The carbohydrate polymer with zinc oxide treatment with venous compression enhances healing of CVUs and improves quality of life due, in part, to its anti-inflammatory properties.
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Affiliation(s)
| | - Lorena Espinosa-Monroy
- Wound and Ostomy Clinic, Division of Research, Hospital Juarez de México, Ministry of Health, Mexico City, Mexico
| | - Tania Orozco-Amaro
- Immunobiology Laboratory, Hospital Juarez de México, Ministry of Health, Mexico City, Mexico
| | - Yessica Torres-Ramos
- Biochemistry Department, National Institute of Perinatology, Ministry of Health, Mexico City, Mexico
| | - Araceli Montoya-Estrada
- Biochemistry Department, National Institute of Perinatology, Ministry of Health, Mexico City, Mexico
| | - Juan Jose Hicks
- Health Research Policies, Coordinating Commission of National Health Institutes and Highly Specialized Hospitals, Mexico City, Mexico
| | | | - Pamela Del Moral
- Health Sciences Faculty, Anahuac University, State of Mexico, Mexico
| | - Jose Moreno
- Immunobiology Laboratory, Hospital Juarez de México, Ministry of Health, Mexico City, Mexico
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Cueto J, Barrientos T, Rodriguez E, Espinosa L, Palma J, Cojab J, Orozco T, Haro A, Del Moral P. Further Experimental Studies on a Biodegradable Adhesive for Protection of Colorectal Anastomosis. Arch Med Res 2014; 45:331-6. [DOI: 10.1016/j.arcmed.2014.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 03/21/2014] [Indexed: 01/01/2023]
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Potent anti-inflammatory activity of carbohydrate polymer with oxide of zinc. BIOMED RESEARCH INTERNATIONAL 2014; 2014:712312. [PMID: 24757670 PMCID: PMC3971507 DOI: 10.1155/2014/712312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/29/2014] [Indexed: 12/21/2022]
Abstract
Pebisut is a biological adhesive composed of naturally occurring carbohydrates combined with zinc oxide (ZnO) initially used as a coadjutant for healing of anastomoses. Likewise some works demonstrated that carbohydrate complexes exerts anti-inflammatory activity and it is widely known that ZnO modulate inflammation. However, the direct effects of Pebisut on isolated cells and acute inflammatory responses remained to be investigated. The present study evaluated anti-inflammatory effect of Pebisut using lipopolysaccharide (LPS) stimulated human mononuclear cells, chemotaxis, and cell infiltration in vivo in a murine model of peritonitis. Our data show that human cells treated with different dilutions of Pebisut release less IL-6, IL-1β, and IL-8 after LPS stimuli compared with the control treated cells. In addition, Pebisut lacked chemotactic activity in human mononuclear cells but was able to reduce chemotaxis towards CCL2, CCL5, and CXCL12 that are representative mononuclear cells chemoattractants. Finally, in a murine model of peritonitis, we found less number of macrophages (F4/80+) and T lymphocytes (CD3+) in peritoneal lavages from animals treated with Pebisut. Our results suggest that Pebisut has anti-inflammatory activity, which might have a beneficial effect during anastomoses healing or wounds associated with excessive inflammation.
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Portilla-de Buen E, Orozco-Mosqueda A, Leal-Cortés C, Vázquez-Camacho G, Fuentes-Orozco C, Alvarez-Villaseñor AS, Macías-Amezcua MD, González-Ojeda A. Fibrinogen and thrombin concentrations are critical for fibrin glue adherence in rat high-risk colon anastomoses. Clinics (Sao Paulo) 2014; 69:259-64. [PMID: 24714834 PMCID: PMC3971357 DOI: 10.6061/clinics/2014(04)07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Fibrin glues have not been consistently successful in preventing the dehiscence of high-risk colonic anastomoses. Fibrinogen and thrombin concentrations in glues determine their ability to function as sealants, healers, and/or adhesives. The objective of the current study was to compare the effects of different concentrations of fibrinogen and thrombin on bursting pressure, leaks, dehiscence, and morphology of high-risk ischemic colonic anastomoses using fibrin glue in rats. METHODS Colonic anastomoses in adult female Sprague-Dawley rats (weight, 250-350 g) treated with fibrin glue containing different concentrations of fibrinogen and thrombin were evaluated at post-operative day 5. The interventions were low-risk (normal) or high-risk (ischemic) end-to-end colonic anastomoses using polypropylene sutures and topical application of fibrinogen at high (120 mg/mL) or low (40 mg/mL) concentrations and thrombin at high (1000 IU/mL) or low (500 IU/mL) concentrations. RESULTS Ischemia alone, anastomosis alone, or both together reduced the bursting pressure. Glues containing a low fibrinogen concentration improved this parameter in all cases. High thrombin in combination with low fibrinogen also improved adherence exclusively in low-risk anastomoses. No differences were detected with respect to macroscopic parameters, histopathology, or hydroxyproline content at 5 days post-anastomosis. CONCLUSIONS Fibrin glue with a low fibrinogen content normalizes the bursting pressure of high-risk ischemic left-colon anastomoses in rats at day 5 after surgery.
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Affiliation(s)
- Eliseo Portilla-de Buen
- Centro de Investigación Biomédica de Occidente, IMSS, Surgical Research Division, Guadalajara, Jal, México
| | - Abel Orozco-Mosqueda
- Transplantation Department, SSG, Hospital Regional de Alta Especialidad del Bajío, León, Gto, México
| | - Caridad Leal-Cortés
- Centro de Investigación Biomédica de Occidente, IMSS, Surgical Research Division, Guadalajara, Jal, México
| | - Gonzalo Vázquez-Camacho
- Cell Biology Laboratory, Instituto Tecnológico de Estudios Superiores de Monterrey, School of Medicine, Campus Guadalajara, Jal, México
| | - Clotilde Fuentes-Orozco
- Surgical Section of the Research Unit in Clinical Epidemiology, CMNO, IMSS, Hospital de Especialidades, Guadalajara, Jal, México
| | | | - Michel Dassaejv Macías-Amezcua
- Surgical Section of the Research Unit in Clinical Epidemiology, CMNO, IMSS, Hospital de Especialidades, Guadalajara, Jal, México
| | - Alejandro González-Ojeda
- Surgical Section of the Research Unit in Clinical Epidemiology, CMNO, IMSS, Hospital de Especialidades, Guadalajara, Jal, México
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