Comparison of Platelet-Rich Plasma-Impregnated Suture Material with Low and High Platelet Concentration to Improve Colonic Anastomotic Wound Healing in Rats

Positive Effect of Platelet-Rich Plasma on Neoureterocystostomy in Rats: An Experimental Study

OBJECTIVES

Some of the most common problems after kidney transplant are urologic complications, including ureterocystoanastomosis leakage and stenosis with the development of severe renal graft complications. Isolated plasma contains active substances that cause the activation of various growth factors for the processes of tissue repair or regeneration, has an anti- inflammatory effect, activates angiogenesis, and reduces the risk of infectious complications. Platelet-rich plasma is actively used to stimulate bone regeneration, heal wounds and ulcers on the skin, enhance reconstruction of the larynx and trachea, and ameliorate urethral damage, among other uses. This study was developed to evaluate the positive effect of platelet-rich plasma on the healing process of an anastomotic wound in a model of ureterocystoanas-tomosis in rats.

MATERIAL AND METHODS

We randomized 14 Wistar albino male rats into 2 groups: group 1 included 7 rats that received platelet-rich plasma after ureterocystostomy; group 2 was the control group and included 7 rats that underwent ureterocystostomy without platelet-rich plasma. On postoperative day 7, all animals were euthanized, and the anastomosis area was resected for determination of the tissue hydroxyproline levels and histopathology examination.

RESULTS

Tissue hydroxyproline levels were 767 ± 62.9 μg/g in group 1 and 256 ± 28.0 μg/g in group 2. Tissue hydroxyproline levels were significantly higher in group 1 compared with group 2 (P < .05). There were no significant differences in epithelial damage, acute inflammation, or fibrosis between the tissue samples of both groups.

CONCLUSIONS

The results of this study show that the use of platelet-rich plasma during ureterocystostomy produces a positive effect. Our further research will be devoted to the use of autologous platelet-rich plasma in ureterocystostomy in big models.

Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

BACKGROUND

Digestive tract resections are usually followed by an anastomosis. Anastomotic leakage, normally due to failed healing, is the most feared complication in digestive surgery because it is associated with high morbidity and mortality. Despite technical and technological advances and focused research, its rates have remained almost unchanged the last decades. In the last two decades, stem cells (SCs) have been shown to enhance healing in animal and human studies; hence, SCs have emerged since 2008 as an alternative to improve anastomoses outcomes.

AIM

To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture leaks.

METHODS

PubMed, Science Direct, Scopus and Cochrane searches were performed using the key words “anastomosis”, “colorectal/colonic anastomoses”, “anastomotic leak”, “stem cells”, “progenitor cells”, “cellular therapy” and “cell therapy” in order to identify relevant articles published in English and Spanish during the years of 2000 to 2021. Studies employing SCs, performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally included. Reference lists from the selected articles were reviewed to identify additional pertinent articles.

Given the great variability in the study designs, anastomotic models, interventions (SCs, doses and vehicles) and outcome measures, performing a reliable meta-analysis was considered impossible, so we present the studies, their results and limitations.

RESULTS

Eighteen preclinical studies and three review papers were identified; no clinical studies have been published and there are no registered clinical trials. Experimental studies, mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis, have been demonstrated SCs as safe and have shown some encouraging morphological, functional and even clinical results. Mesenchymal SCs are mostly employed, and delivery routes are mainly local injections and cell sheets followed by biosutures (sutures coated by SCs) or purely topical. As potential weaknesses, animal models need to be improved to make them more comparable and equivalent to clinical practice, and the SC isolation processes need to be standardised. There is notable heterogeneity in the studies, making them difficult to compare. Further investigations are needed to establish the indications, the administration system, potential adjuvants, the final efficacy and to confirm safety and exclude definitively oncological concerns.

CONCLUSION

The future role of SC therapy to induce healing processes in digestive anastomoses/sutures still needs to be determined and seems to be currently far from clinical use.

Platelet rich plasma effectiveness in bowel anastomoses: A systematic review

BACKGROUND

Anastomotic leak constitutes a major problem in abdominal surgery. Technical insufficiency, topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage, with detrimental effects on patient postoperative outcomes. Despite the investigation of several factors and the invention of protective materials, the ideal agent to prevent anastomotic leaks is yet to be determined.

AIM

To study the effect of platelet rich plasma (PRP) on the healing of bowel anastomoses.

METHODS

A systematic literature search was performed in PubMed, EMBASE, and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis.

RESULTS

Eighteen studies were eligible with a total population of 712 animals including rats (14 studies), rabbits (2 studies) and pigs (2 studies). No postoperative complications were reported following PRP application. Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention, such as intraperitoneal chemotherapy or peritonitis. Similar results were reported by ten studies in terms of tissue hydroxyproline levels. One study reported significant increase in collagen deposition in PRP groups. PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy (6 studies).

CONCLUSION

The application of PRP is associated with improved bowel anastomosis outcomes, especially in animal models having an underlying condition affecting the normal healing process. PRP application seems to augment the normal healing process under these circumstances. However, further studies are needed to investigate the potential role of PRP on bowel anastomosis healing, especially in clinical settings.