Premium
A light‐activated amnion wrap strengthens colonic anastomosis and reduces peri‐anastomotic adhesions
Author(s) -
SenthilKumar Prabhu,
Ni Tao,
Randolph Mark A.,
Velmahos George C.,
Kochevar Irene E.,
Redmond Robert W.
Publication year - 2016
Publication title -
lasers in surgery and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.888
H-Index - 112
eISSN - 1096-9101
pISSN - 0196-8092
DOI - 10.1002/lsm.22507
Subject(s) - anastomosis , medicine , laparotomy , fibrous joint , surgery , amnion , cuff , adhesion , urology , anatomy , chemistry , fetus , biology , pregnancy , genetics , organic chemistry
Background and Objective Colonic anastomotic failure is a dreaded complication, and multiple surgical techniques have failed to eliminate it. Photochemical tissue bonding (PTB) is a method of sealing tissue surfaces by light‐activated crosslinking. We evaluated if a human amniotic membrane (HAM), sealed over the anastomotic line by PTB, increases the anastomotic strength. Study Design Sprague–Dawley rats underwent midline laparotomy followed by surgical transection of the left colon. Animals were randomized to colonic anastomosis by one of the following methods (20 per group): single‐layer continuous circumferential suture repair (SR); SR with a HAM wrap attached by suture (SR+ HAM‐S); SR with HAM bonded photochemically over the anastomotic site using 532 nm light (SR+ HAM‐PTB); approximation of the bowel ends with only three sutures and sealing with HAM‐PTB (3+ HAM‐PTB). A control group underwent laparotomy alone with no colon resection (NR). Sub‐groups ( n = 10) were sacrificed at days 3 and 7 post‐operatively and adhesions were evaluated. A 6 cm section of colon was then removed and strength of anastomosis evaluated by burst pressure (BP) measurement. Results A fourfold increase in BP was observed in the SR+ HAM‐PTB group compared to suture repair alone (94 ± 3 vs. 25 ± 8 mm Hg, P < 0.0001) at day 3. At day 7 the burst pressures were 165 ± 40 and 145 ± 31 mm Hg ( P = 1), respectively. A significant decrease in peri‐anastomotic adhesions was observed in the SR+ HAM‐PTB group compared to the SR group at both time points ( P < 0.001). Conclusion Sealing sutured colonic anastomotic lines with HAM‐PTB increases the early strength of the repair and reduces peri‐anastomotic adhesions. Lasers Surg. Med. 48:530–537, 2016. © 2016 Wiley Periodicals, Inc.