Obsidian ASG® Autologous Platelet-Rich Fibrin Matrix and Colorectal Anastomotic Healing: A Preliminary Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Andreas Shamiyeh ◽  
◽  
Bettina Klugsberger ◽  
Carina Aigner ◽  
Wolfgang Schimetta ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Anastomotic Leak ◽  
Colorectal Resection ◽  
Rectal Resection ◽  
Leak Rate ◽  
Anastomotic Healing ◽  
Platelet Rich Fibrin ◽  
Anastomotic Leak Rate ◽  
Fibrin Matrix ◽  
Autologous Platelet

Introduction: Anastomotic leakage (AL) following colorectal resection is a devastating complication affecting morbidity, mortality, and quality of life of patients in the long term. Different tissue sealants and biologic glues were tested showing conflicting results regarding their influence on anastomotic healing and leak prevention. Application of autologous platelet-rich fibrin (Vivostat A/S, Alleroed, Denmark), which acts as a source of angiogenic growth factors and cytokines, showed promising results in an in-vivo porcine model. Herein, we present the first human study of stapled colorectal anastomoses supplemented with an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®, Rivolution GmbH, Rosenheim, Germany and Vivostat A/S, Alleroed, Denmark). Materials and Methods: A retrospective analysis of prospectively accumulated data was performed in two colorectal centers (Linz, Vienna) on patients undergoing left-sided colorectal or coloanal stapled anastomosis between October 2018 and December 2019. The Obsidian ASG® Matrix was applied to the rectal stump, and after closure with the circular stapling device, at the circumference of anastomosis in every single case. Anastomoses were supplemented with intra- and extra-anastomotic application (IAA—intra-anastomotic application developed by Rivolution GmbH, Rosenheim, Germany) of Obsidian ASG® Matrix. The primary endpoints were incidence of perioperative complications and anastomotic leak rate. Results: Two-hundred-sixty-one (138 female) patients underwent left-sided colonic (n=177) or rectal resection (n=84). In 253 (96.9%) cases, a laparoscopic or robotic-assisted approach was used. There were no complications attributable to the intraoperative application of the Obsidian ASG® Matrix. All intraoperative leak tests were negative. Overall, anastomotic leak rate accounted for 2.3% (6/261). AL following colonic and rectal resection was seen in 2.3% (4/177) and 2.4% (2/84), respectively. Complication and leak rate was similar in the two participating centers. Postoperative fever and elevated CRP levels were significantly correlated to AL. There was no significant risk factor for AL on multivariate analysis. Conclusion: Application of an autologous-derived platelet-rich fibrin matrix (Obsidian ASG®) at anastomotic site following colorectal resection is safe and associated with a low rate of anastomotic leakage.

Anastomotic Leak Rate after Low Anterior Resection for Rectal Cancer after Chemoradiation Therapy

2010 ◽  
Vol 76 (8) ◽  
pp. 869-871 ◽  
Author(s):  
Benjamin R. Phillips ◽  
Lisa J. Harris ◽  
Pinckney J. Maxwell ◽  
Gerald A Isenberg ◽  
Scott D. Goldstein
Keyword(s):  
Anastomotic Leak ◽  
Rectal Resection ◽  
Colorectal Anastomosis ◽  
Neoadjuvant Chemoradiation ◽  
Contrast Enema ◽  
Chemoradiation Therapy ◽  
Leak Rate ◽  
Stoma Reversal ◽  
Anastomotic Leak Rate ◽  
Preoperative Chemoradiation Therapy

Anastomotic leak may be the most concerning complication after colorectal anastomosis. To compare open with laparoscopic rectal resection, we must have accurate leak rates in patients who have received neoadjuvant chemoradiation therapy to serve as a benchmark for comparison. All patients who had preoperative chemoradiation therapy with rectal resection and low pelvic anastomosis for cancer in a single colorectal practice over a 7-year period were retrospectively reviewed. All patients had proximal diversion and a contrast enema study before stoma reversal. Eighty-seven consecutive patients were included in the study. Average age was 58 years. Fifty-nine per cent of patients were male. Sixty-six per cent were smokers. Pathologic T stage was 5 per cent TO, 16 per cent T1, 28 per cent T2, 47 per cent T3, and 5 per cent T4. Seventy-five per cent of patients were pathologically lymph node-negative. Average time to stoma reversal was 122 days. Total anastomotic leak rate was 10.3 per cent (8% clinical leaks). Five (56%) patients with leak successfully underwent reversal of their diverting stoma (average time to reversal, 290 days). Patients who had the complication of anastomotic leakage had less likelihood of stoma reversal and a significantly prolonged time to stoma reversal.

Histologic changes in early colonic anastomotic healing using autologous platelet-rich fibrin matrix

2019 ◽  
Vol 52 (4) ◽  
pp. 155-164
Author(s):  
Bernhard Dauser ◽  
Wolf Heitland ◽  
Franz G. Bader ◽  
Walter Brunner ◽  
Yael Nir ◽  
...  
Keyword(s):  
Anastomotic Healing ◽  
Platelet Rich Fibrin ◽  
Fibrin Matrix ◽  
Histologic Changes ◽  
Colonic Anastomotic Healing ◽  
Autologous Platelet

scholarly journals Human Oral Mucosal Stem Cells Reduce Anastomotic Leak in an Animal Model of Colonic Surgery

2021 ◽  
pp. 1-8
Author(s):  
Ilan Kent ◽  
Cyrus Jahansouz ◽  
Amandeep Ghuman ◽  
Baruch Shpitz ◽  
Debora Kidron ◽  
...  
Keyword(s):  
Stem Cells ◽  
Anastomotic Leak ◽  
Murine Model ◽  
Colonic Anastomosis ◽  
Colon Surgery ◽  
Leak Rate ◽  
Colonic Surgery ◽  
Colon Wall ◽  
Anastomotic Leak Rate ◽  
Suture Anastomosis

<b><i>Background:</i></b> Anastomotic leak is regarded as one of the most feared complications of bowel surgery; avoiding leaks is a major priority. Attempts to reduce or eliminate leaks have included alternate anastomotic techniques. Human oral mucosa stem cells (hOMSC) are self-renewing and expandable cells derived from buccal mucosa. Studies have shown that hOMSC can accelerate tissue regeneration and wound healing. The objective of this study was to evaluate whether hOMSC can decrease anastomotic leak rates in a murine model of colon surgery. <b><i>Methods:</i></b> Two experiments were performed. In the first study, mice underwent colonic anastomosis using five interrupted sutures. hOMSC (<i>n</i> = 7) or normal saline (NS; <i>n</i> = 17) was injected into the colon wall at the site of the anastomosis. To evaluate whether hOMSC can impact anastomotic healing, the model was stressed by repeating the first experiment, reducing the number of sutures used for the construction of the anastomosis from five to four. Either hOMSC (<i>n</i> = 8) or NS (<i>n</i> = 20) was injected at the anastomosis. All mice that survived were sacrificed on postoperative day 7. Anastomotic leak rate, mortality, daily weight, and daily wellness scores were compared. <b><i>Results:</i></b> In the five-suture anastomosis, there were no differences in anastomotic leak rate, mortality, or daily weight. Mice that received hOMSC had significantly higher wellness scores on postoperative day 2 (<i>p</i> &#x3c; 0.05). In the four-suture anastomosis, there was a significant decrease in leak rate (70% [NS] vs. 25% [hOMSC], <i>p</i> = 0.029) and higher wellness scores in mice that received hOMSC (<i>p</i> &#x3c; 0.05). <b><i>Conclusion:</i></b> Our study suggests that injecting hOMSC at the colonic anastomosis can potentially reduce anastomotic leak and improve postoperative wellness in a murine model of colon surgery.

scholarly journals Best evidence topic: Is ileocolic anastomotic leak rate higher in handsewn or stapler's anastomosis?

2020 ◽  
Vol 60 ◽  
pp. 619-622
Author(s):  
Sabry Abounozha ◽  
Adel Kheder ◽  
Talal Alshahri ◽  
Rashid Ibrahim
Keyword(s):  
Anastomotic Leak ◽  
Leak Rate ◽  
Anastomotic Leak Rate

PWE-157 Reducing anastomotic leak rate in ivor lewis oesophagectomy – testing a change from mechanical to semi-mechanical anastomosis

Gut ◽  
2015 ◽  
Vol 64 (Suppl 1) ◽  
pp. A281.2-A282 ◽  
Author(s):  
J Clark ◽  
G Sanders ◽  
T Wheatley ◽  
P Peyser ◽  
J Rahamim ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Leak Rate ◽  
Ivor Lewis ◽  
Anastomotic Leak Rate ◽  
Mechanical Anastomosis

548 COMPARISON OF ESOPHAGECTOMY OUTCOMES BETWEEN A NATIONAL CENTER, A NATIONAL AUDIT COLLABORATIVE, AND AN INTERNATIONAL DATABASE USING ECCG STANDARDIZED DEFINITIONS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
John V Reynolds ◽  
Jessie A Elliott ◽  
Noel Donlon ◽  
Claire Donohoe ◽  
Narayanasamy Ravi ◽  
...  
Keyword(s):  
Anastomotic Leak ◽  
Leak Rate ◽  
Collaborative Group ◽  
Surgical Approaches ◽  
Consecutive Series ◽  
Recurrent Nerve ◽  
En Bloc ◽  
Curative Intent ◽  
Chyle Leak ◽  
Anastomotic Leak Rate

Abstract   The ECCG developed a standardized platform for reporting operative complications, with consensus definitions, and DUCA adopted these definitions and have reported a comparison against these benchmarks. The aim of this study was to report five year complications data using the standardized definitions of the Esophageal Complications Consensus Group (ECCG), and to compare with published ECCG benchmark studies from the collaborative group and from the Dutch Upper Gastrointestinal Cancer Audit (DUCA). Methods All patients undergoing multimodal therapy or surgery with curative intent from 2014 to 2018 inclusive were studied. All data were recorded prospectively and maintained internally as well as entered onto a secure online database (Esodata.org) from 2015. Statistical analysis was performed using SPSS® (version 18.0). Results 219 patients (mean age 67; 77% male) underwent open resection, 66.6% via transthoracic en bloc resection. 30-day and 90-day mortality were 0.0 and 0.9%, respectively. The anastomotic leak rate was 5.4%, and chyle leak 5.4%. Pneumonia was recorded in 18.2%, respiratory failure 10.9%, and ARDS in 2.7%. Atrial dysrhythmia occurred in 22.8%, recurrent nerve injury 3.1%, and delirium in 5.0%. Compared with both ECCG and DUCA, where MIE constituted 47% and 86% of surgical approaches, respectively, overall complications were similar in this open series, as was complications severity, however anastomotic leak rate were several-fold less, and mortality rates were lower. Conclusion In this unselected consecutive series and comparative audit with benchmark averages from the ECCG and DUCA publication, a low mortality and anastomotic leak rate were the key differential findings. Although not risk-stratified or directly matched, the severity of complications from this ‘open’ series is consistent with series containing large numbers of total or hybrid MIE, highlighting a need to adhere to these strictly defined definitions in further prospective research and randomized studies.

Volume-outcome Relationship in Rectal Cancer Surgery

2021 ◽  
Author(s):  
Leandro Siragusa ◽  
Bruno Sensi ◽  
Danilo Vinci ◽  
Marzia Franceschilli ◽  
Giulia Bagaglini ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Operative Time ◽  
Cancer Surgery ◽  
Leak Rate ◽  
Perioperative Outcomes ◽  
Rectal Cancer Surgery ◽  
Anastomotic Leak Rate

Abstract Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR).Methods A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes.Results 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.05). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p <0.05) were also significantly reduced in Group A.Conclusion: This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.

PS01.212: OUTCOMES OF HYBRID VERSUS FULLY MINIMALLY INVASIVE 2-STAGE ESOPHAGECTOMY FOR CANCER OF THE DISTAL ESOPHAGUS AND GASTRO-ESOPHAGEAL JUNCTION

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 110-110
Author(s):  
Kanatheepan Shanmuganathan ◽  
Temisanren Akitikori ◽  
Oluwasunmisola Soile ◽  
Aadil Hussain ◽  
Neda Farhangmehr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Minimally Invasive Esophagectomy ◽  
Hospital Length ◽  
Leak Rate ◽  
Hospital Length Of Stay ◽  
Cardiac Complications ◽  
Invasive Esophagectomy ◽  
Anastomotic Leak Rate

Abstract Background Esophagectomy is associated with high complication rate and mortality. Numerous approaches have been introduced over the last two decades, with the ambition of reducing rate of complications, morbidity and mortality. Two-stage minimally invasive esophagectomies include hybrid (laparoscopic/thoracotomic) and fully minimally invasive and have recently gained popularity in the treatment of distal esophageal and gastro-esophageal junction cancer. We aim to compare the short-term outcomes between 2-stage hybrid and fully minimally invasive esophagectomy with intrathoracic hand-sewn anastomosis. Methods A retrospective analysis of a 4-year period prospectively collected data of 100 consecutive 2-stage minimally invasive esophagectomies was conducted. All operations were performed in a UK tertiary centre by a single surgical team between 2014 and 2018. All 3-stage and open esophagectomies were excluded from the study. A comparison of anastomotic leak rate, ITU length of stay, hospital length of stay, pulmonary complications, cardiac complications and 30 and 90-day mortality rates was made. Statistical analysis was performed using Graph-Prism 7.04. Results Seventy patients underwent hybrid and 30 underwent fully minimally invasive esophagectomy with intra-thoracic manual anastomosis. Chest infection and anastomotic leak rate were higher in the hybrid group (21.4% vs 16.8% and 10% vs 3.3%); however, cardiac complications were two times more common in fully minimally invasive compared to hybrid esophagectomies (3.3% vs 1.4%). Fully minimally invasive esophagectomies were associated with a shorter ITU stay as well as hospital length of stay compared to hybrid esophagectomies (5.5 vs 6.2 days, P = 0.47 and 10.5 vs 15.6 days P = 0.0018). Complete tumour resection (R0) rate was slightly higher in hybrid compared to fully minimally invasive esophagectomies (70.8% vs 64.3%). Thirty and 90-day mortality rate was 6.67% (1 cardiac and 1 respiratory arrest) in fully minimally invasive and 1.43% in hybrid esophagectomies. None of the mortality cases were related to surgical complications like anastomotic leak or conduit necrosis. Conclusion In our study 2-stage fully minimally invasive esophagectomy is associated with reduced post-operative complication rates compared to 2-stage hybrid oesophagectomy. Further larger studies are needed to assess the 30- and 90-day mortality risk associated with both procedures. Disclosure All authors have declared no conflicts of interest.

FA05.05: PROLONGED LAPAROSCOPIC GASTRIC ISCHEMIC CONDITIONING PRIOR TO ESOPHAGECTOMY IN PATIENTS OF ESOPHAGEAL CANCER: FEASIBILITY AND CLINICAL SIGNIFICANCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 11-11
Author(s):  
Kalayarasan Raja
Keyword(s):  
Anastomotic Leak ◽  
Ischemic Preconditioning ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Leak Rate ◽  
Time Interval ◽  
Carcinoma Of The Esophagus ◽  
Anastomotic Complications ◽  
Ischemic Conditioning ◽  
Anastomotic Leak Rate

Abstract Background The studies on gastric ischemic preconditioning in improving blood flow to the distal gastric conduit and reducing the incidence of anastomotic complications have yielded variable results. Lack of adequate time interval between gastric ischemic preconditioning and esophagectomy has been postulated as one of the reasons for lack of clinical benefit. Hence the present study was done to evaluate the feasibility and clinical outcome of prolonged gastric ischemic conditioning prior to esophagectomy. Methods Patients with locally advanced squamous cell carcinoma of the esophagus planned for neoadjuvant chemoradiotherapy followed by esophagectomy and gastric pull through were included in the prospective study. Prior to initiation of neoadjuvant therapy laparoscopic feeding jejunostomy with ischemic preconditioning by the ligation of left and the short gastric vessel was performed. All patients underwent thoracolaparoscopic esophagectomy with two field esophagectomy and cervical esophagogastric anastomosis using modified Orringer technique. Radiological assessment of the caliber of the right gastroepiploic artery (RGEA) and Immunohistologic analysis of Hypoxia-inducible factor – 1 alpha (HIF-1alpha) expression in the fundus to determine the degree of neovascularization was performed after ischemic preconditioning. The feasibility of laparoscopic gastric mobilization post ischemic preconditioning and cervical anastomotic leak rate was documented and compared with patients who did not undergo ischemic preconditioning. Results Fifteen patients underwent thoracolaparoscopic esophagectomy after a median time of 124 days post laparoscopic gastric ischemic preconditioning. Minor adhesions present in the gastrosplenic region did not interfere with laparoscopic gastric mobilization. The mean pre-ischemic conditioning diameter of RGEA increased from 2.18 mm to 2.25 mm post ischemic conditioning (P = 0.21). The median HIF-1 alpha index post ischemic conditioning was 0.6. The cervical anastomotic leak rate was less in patients who underwent ischemic preconditioning (1/14, 7.1%) compared to the patients who did not undergo ischemic preconditioning (6/16, 37.5%), although the difference was not statistically significant (P = 0.24) Conclusion Prolonged gastric ischemic preconditioning prior to esophagectomy is safe and does not interfere with laparoscopic gastric mobilization. It can potentially reduce cervical anastomotic complications post neoadjuvant chemoradiotherapy. Disclosure All authors have declared no conflicts of interest.

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