Obesity Surgery

, Volume 29, Issue 11, pp 3560–3568 | Cite as

The Positive Effects of the Human Amniotic Membrane on the Healing of Staple Line After Sleeve Gastrectomy Applied Long-Evans Rat Model

  • Murat Ferhat FerhatogluEmail author
  • Taner Kıvılcım
  • Kazım Senol
  • Gurcan Vural
  • Abdulcabbar Kartal
  • Said İncir
  • Ali İlker Filiz
  • Abut Kebudi
Original Contributions



The staple line leakage is a dangerous complication of sleeve gastrectomy. Various strategies have been tried to reduce the leakage risk. The amniotic membrane (AmM) is the inner layer of the placental membranes and has anti-inflammatory, anti-fibrosis, and anti-scarring effects, and it also has lower immune characteristics which are another essential characteristic of AmM concerning its utility for grafting. In this study, we aimed to investigate the impact of AmM on the staple line healing process of sleeve gastrectomy model in rats.

Materials and Methods

We used twenty-eight Long-Evans rats in this study. Sleeve gastrectomy was performed with tristapler. Fourteen rats served as controls, AmM was applied staple line of the other fourteen. Fourteen animals were sacrificed (seven from the AmM applied group and the other seven from the control group) on the third postoperative day. And, the other fourteen animals were sacrificed (seven from the AmM applied group and seven from the control group) on the seventh postoperative day. The tissue around the staple line was evaluated microscopically and macroscopically, bursting pressures and hydroxyproline levels were also measured.


The bursting pressure and hydroxyproline measurements of the AmM applied group was significantly higher on the seventh postoperative day (p = 0.015, p = 0.012) Fibroblast activity and neoangiogenesis of the AmM applied group was also significantly higher on the seventh postoperative day (p = 0.004, p = 0.002).


This study showed that covering of staple line of sleeve gastrectomy model in rats significantly provided higher bursting pressures and increased hydroxyproline levels, fibroblast activity, and neoangiogenesis which may potentially lead a better staple line healing. We think further investigations are needed on this issue.


Sleeve gastrectomy Amniotic membrane Staple line healing Leakage Complication 



The authors of this manuscript would like to thank Veterinary Burcu Cevreli for her expert advice on this project.

Authors’ Contributions

MFF, TK, KS, and SI collected the information, reviewed the literature, and wrote the manuscript. AcK, GV, and MFF collected the information. AIF and AK critically reviewed the manuscript and approved the final form. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures in the study performed by following the Guidelines for the Care and Use of Laboratory Animals (National Institutes of Health publication no. 83-26, revised 1985, Bethesda, MD, USA) and the Guidelines of the Animal Welfare Act. And, the Uskudar University, Board of Biological Experiments with Living Animals approved the experimental protocol (April 26, 2018–15).

Informed Consent Statement

For this type of study formal consent is not required.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medicine, Departmet of General SurgeryIstanbul Okan UniversityIstanbulTurkey
  2. 2.Faculty of Medicine, Departmet of General SurgeryUludag UniversityBursaTurkey
  3. 3.Faculty of Medicine, Departmet of PathologyIstanbul Okan UniversityIstanbulTurkey
  4. 4.Faculty of Medicine, Departmet of BiochemistryKoc UniversityIstanbulTurkey

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