Light‐activated photosealing with human amniotic membrane strengthens bowel anastomosis in a hypotensive, trauma‐relevant swine model

Abstract

Background: Gastrointestinal anastomotic leakage is a dreaded complication despite advancements in surgical technique. Photochemical tissue bonding (PTB) is a method of sealing tissue surfaces utilizing photoactive dye. We evaluated if crosslinked human amniotic membrane (xHAM) photosealed over the enteroenterostomy would augment anastomotic strength in a trauma-relevant swine hemorrhagic shock model. Methods: Yorkshire swine (40-45 kg, n = 14) underwent midline laparotomy and sharp transection of the small intestine 120 cm proximal to the ileocecal fold. Immediately following intestinal transection, a controlled arterial bleed was performed to reach hemorrhagic shock. Intestinal repair was performed after 60 minutes and autotransfusion of the withdrawn blood was performed for resuscitation. Animals were randomized to small intestinal anastomosis by one of the following methods (seven per group): suture repair (SR), or SR with PTB augmentation. Animals were euthanized at postoperative Day 28 and burst pressure (BP) strength testing was performed on all excised specimens. Results: Mean BP for SR, PTB, and native tissue groups were 229 ± 40, 282 ± 21, and 282 ± 47 mmHg, respectively, with the SR group statistically significantly different on analysis of variance (p = 0.02). Post-hoc Tukey all-pairs comparison demonstrated a statistically significant difference in burst pressure strength between the SR only and the PTB group (p = 0.04). All specimens in SR group ruptured at the anastomosis upon burst pressure testing, while all specimens in the PTB group ruptured at least 2.5 cm from the anastomosis. Conclusion: Photosealing with xHAM significantly augments the strength of small intestinal anastomosis performed in a trauma porcine model.

Application of amniotic membranes in reconstructive surgery of internal organs—A systematic review and meta‐analysis

“…The PRISMA flowchart is shown in Figure 2. Sixty references containing 26 human studies (Ambrus, 1967; Barski et al., 2015; Catalano & Conticello, 1968; De Weerd et al., 2013, 2020; Eichberg et al., 2018, 2019; Frigerio et al., 2019; Ghahramani et al., 2017; Kakabadze et al., 2016; Kumar et al., 2015; Marton et al., 2021; Pignatti et al., 2020; Price & Price, 2016; Razzaghi et al., 2020; Rohleder et al., 2013; Schoellhammer et al., 2018; Schrimpf, 1954; Singh et al., 2011; Tahami et al., 2020; Tomita et al., 2012; Ts'ao, 1960; Tumanov et al., 2006; Turchan et al., 2018; Walker et al., 2018; Zmijewski & Pietraszek, 2005) and 36 animal studies (Barski et al., 2017; Brown et al., 2014; Demir et al., 2021; Ercin et al., 2019; Erdener et al., 1992; Ferhatoglu et al., 2019; Fishman et al., 1987; Francisco et al., 2016; Ghahramani et al., 2014; Güneş et al., 2016, 2017; Hariastawa et al., 2020; Iijima et al., 2007; Ismail, Marcos, et al., 2009; Ismail, Ramsis, et al., 2009; Kesting et al., 2008, 2010; Li et al., 2019; Liu et al., 2021; Mohajeri et al., 2014; Moslemi et al., 2016; Orman et al., 2020; Rohleder et al., 2013; Roshanravan et al., 2014; Schimidt et al., 2010; Scott et al., 2021; Scudamore et al., 1988; Senthil‐Kumar et al., 2016; Tomita et al.,…”

“…The MA showed lower inflammation scores for the AM group (Figure 6 ). Other studies only described the inflammatory response, mostly a mild transient or absent inflammation process (Erdener et al., 1992 ; Ghahramani et al., 2014 ; Güneş et al., 2017 ; Iijima et al., 2007 ; Ismail, Ramsis, et al., 2009 ; Kesting et al., 2010 ; Schimidt et al., 2010 ; Scott et al., 2021 ; Tomita et al., 2012 ; Tsuda et al., 1996 , 1999 ).…”

“…The human studies did not assess mechanical strength of the repair. In the animal studies, the mechanical strength of the surgical repair was reported in seven studies (Ferhatoglu et al., 2019 ; Scott et al., 2021 ; Senthil‐Kumar et al., 2016 ; Uludag et al., 2009a , 2009b ; Uludag, Citgez, et al., 2010 ; Uludag, Ozdilli, et al., 2010 ). The MA conducted on bursting pressure showed higher bursting pressure results in the AM group than control (Figure 9 , Table S6 ).…”

“…( 2009a , 2009b , 2010 ) were assessed on day 3 and 7; the outcomes of Scott et al. ( 2021 ) were assessed on day 28; the outcomes of Uludag, Ozdilli, et al. ( 2010 ) were assessed on day 4 and 8.…”

“…Price, 2016;Razzaghi et al, 2020;Rohleder et al, 2013;Schoellhammer et al, 2018;Schrimpf, 1954;Singh et al, 2011;Tahami et al, 2020;Tomita et al, 2012;Ts'ao, 1960;Tumanov et al, 2006;Turchan et al, 2018;Walker et al, 2018;Zmijewski & Pietraszek, 2005) and 36 animal studies(Barski et al, 2017;Brown et al, 2014;Demir et al, 2021;Ercin et al, 2019;Erdener et al, 1992;Ferhatoglu et al, 2019;Fishman et al, 1987; Francisco et al, 2016;Ghahramani et al, 2014;Güneş et al, 2016Güneş et al, , 2017Hariastawa et al, 2020;Iijima et al, 2007;Ismail, Marcos, et al, 2009;Ismail, Ramsis, et al, 2009;Kesting et al, 2008Kesting et al, , 2010Li et al, 2019;Liu et al, 2021;Mohajeri et al, 2014;Moslemi et al, 2016;Orman et al, 2020;Rohleder et al, 2013;Roshanravan et al, 2014;Schimidt et al, 2010;Scott et al, 2021;Scudamore et al, 1988;Senthil-Kumar et al, 2016;…”