Comparative Clinical Pathology

, Volume 25, Issue 6, pp 1121–1126 | Cite as

Effect of human amniotic membrane on anastomosis leakage in dog model

  • Mehdi Tahamtan
  • Seyed Vahid Hosseini
  • Hajar Khazraei
  • Majid Forozesh
  • Alimohammad Bananzadeh
  • Maral Mokhtari
  • Shahla Fereidooni
Original Article

Abstract

One of the major concerns in rectal cancer surgery and complicated anastomosis is anastomosis breakdown and leakage. For decades, radiation (as neoadjuvant or adjuv ant therapy) was known as a risk factor for anastomosis leakage. Diverting loop ileostomy has been usually employed to divert the fecal flow and protect complicated anastomosis. However, there is a high rate of complications related to diverting loop ileostomy and its closure. This experimental study was carried out to investigate the effect of human amniotic membrane on colonic anastomosis in dogs that underwent preoperative radiation therapy. In this prospective controlled animal trial study, a total of ten male cross-breed dogs aged 6–8 months and weighing 10–15 kg were randomly assigned in to two groups of five dogs. Group 1 with five dogs received 10 Gy of external radiation preoperatively, while the second didn’t receive radiation. After anesthesia and exploration, about 8 cm above the dentate line, the bowel was cut and end-to-end anastomosis was done in two layers hand sewn technique. HAM measuring 2.5 cm × 2.5 cm was wrapped around the anastomosis and sutured with vicryl 3-0. In each group, one of the dogs died. The non-parametric Mann—Whitney test was used to compare the two groups. Two-tailed P value <0.05 was considered statistically significant. Cross sections of the healed anastomosis were scored according to modified scoring system. Histological evaluation of both groups demonstrated ulceration of the mucosa with infiltration of the acute and chronic inflammatory cells as well as granulation tissue formation. The healing starts by fibroblast proliferation and collagen deposition. A thin fibrotic tissue was formed between the serosa and patch graft. (P > 0.05, i.e., healing in both irradiated and non-irradiated groups was the same). Unfavorable effects of radiotherapy and loop ileostomy may be resolved with application of human amniotic membrane, which influences anastomosis healing and eliminates the need for ileostomy insertion.

Keywords

Anastomosis healing Ileostomy Colon 

References

  1. Abramov Y, Golden B, Sullivan M, Botros SM, Miller JJ, Alshahrour A, et al. (2007) Histologic characterization of vaginal vs. abdominal surgical wound healing in a rabbit model. Wound Repair Regen 15(1):806CrossRefGoogle Scholar
  2. Buie WD, MacLean AR, Attard JA, Brasher PM, Chan AK (2005) Neoadjuvant chemoradiation increases the risk of pelvic sepsis after radical excision of rectal cancer. Dis Colon rectum 48:1868–1874Google Scholar
  3. Bullard KM, Trudel JL, Baxter NN, Rothenberger DA (2005) Primary perineal wound closure after preoperative radiotherapy and abdominoperineal resection has a high incidence of wound failure. Dis Colon rectum 48(3):438–443Google Scholar
  4. Chamlou R, Parc Y, Simon T, et al. (2007) Long-term results of intersphincteric resection for low rectal cancer. Ann Surg 246:916–921CrossRefPubMedGoogle Scholar
  5. Dormand EL, Banwell PE, Goodacre TE (2005) Radiotherapy and wound healing. Int Wound J 2:112–127Google Scholar
  6. Erdem E, Dinç S, Erdem D, et al. (2002) Effects of intraperitoneal chemotherapy and GM-CSF on anastomotic healing: an experimental study in rats. J Surg Res 108:1–6CrossRefPubMedGoogle Scholar
  7. Felnbeg SM, McLeod RS, Cohen Z (1997) Complications of loop lleostomy. Am J Surg 153:102–107Google Scholar
  8. Haubner F, Ohmann E, Pohl F, Strutz J, Gassner HG (2012) Wound healing after radiation therapy: review of the literature. Radiat Oncol 7:162CrossRefPubMedPubMedCentralGoogle Scholar
  9. Hopewell JW (1990) The skin: its structure and response to ionizing radiation. Int J Radiat Biol 57:751–773CrossRefPubMedGoogle Scholar
  10. Kesting MR, Loeffelbein DJ, Steinstraesser L, Muecke T, Demtroeder C, Sommerer F, et al. (2008a) Cryopreserved human amniotic membrane for soft tissue repair in rats. Ann Plast Surg 60:684–691CrossRefPubMedGoogle Scholar
  11. Kesting MR, Wolff KD, Hohlweg-Majert B, Steinstraesser L (2008b) The role of allogenic amniotic membrane in burn treatment. J Burn Care Res 29:907–916CrossRefPubMedGoogle Scholar
  12. Milsom J, Senagore A, Walshaw R, Mostosky U, Wang P, Johnson W, Chaudry I (1992) Preoperative radiation therapy produces an early and persistent reduction in colorectal anastomotic blood flow. J Surg Res 53:464–469CrossRefPubMedGoogle Scholar
  13. Mohammadi AA, Seyed Jafari SM, Kiasat M, Tavakkolian AR, Imani MT, Ayaz M, et al. (2013) Effect of fresh human amniotic membrane dressing on graft take in patients with chronic burn wounds compared with conventional methods. Burns 39:349–353CrossRefPubMedGoogle Scholar
  14. Mucke T, Loeffelbein DJ, Holzle F, Slotta-Huspenina J, Borgmann A, Kanatas AN, et al. (2010) Intraoral defect coverage with prelaminated epigastric fat flaps with human amniotic membrane in rats. J Biomed Mater Res B Appl Biomater 95(2):466–474CrossRefPubMedGoogle Scholar
  15. Mutlu-Turkoglu U, Erbil Y, Oztezcan S, Olgac V, Toker G, Uysal M (2000) The effect of selenium and/or vitamin E treatments on radiation-induced intestinal injury in rats. Life Sci 66(20):1905–1913CrossRefPubMedGoogle Scholar
  16. Najibpour N, Jahantab MG, Hosseinzadeh M, Roshanravan R, Moslemi S, Rahimikazerooni S, et al. (2013) The effects of human amniotic membrane on healing of colonic anastomosis in dogs. Ann Colorectal Res 1(3):97–100CrossRefGoogle Scholar
  17. Nayci A, Cakmak M, Renda N (2003) Effect of electromagnetic fields and early postoperative 5-fluorouracil on the healing of colonic anastomoses. Int J Color Dis 18:136–141Google Scholar
  18. Niknejad H, Peirovi H, Jorjani M, Ahmadiani A, Ghanavi J, Seifalian AM (2008) Properties of the amniotic membrane for potential use in tissue engineering. european and Materials 15:88–99Google Scholar
  19. Nordentoft T, Pommergaar HS, Rosenberg J, Achiam MP (2015) Fibrin glue does not improve healing of gastrointestinal anastomoses: a systematic review. Eur Surg Res 54:1–13CrossRefPubMedGoogle Scholar
  20. Omidvari S, Hamedi SH, Mohammadianpanah M, Razzaghi S, Mosalaei A, Ahmadloo N, et al. (2013) Comparison of abdominoperineal resection and low anterior resection in lower and middle rectal cancer. Journal of the Egyptian National Cancer Institute 25(3):151–160CrossRefPubMedGoogle Scholar
  21. Roshanravan R, Ghahramani L, Hosseinzadeh M, Safarpour AR, Rahimikazerooni S, Hosseini SV, et al. (2013) A new method to repair recto-vaginal fistula; use of human amniotic membrane in an animal model. J Advanced Biomed Res 3Google Scholar
  22. Singh R, Chouhan US, Purohit S, Gupta P, Kumar P, Kumar A, Chacharkar MP, Kachhawa D, Ghiya BC (2004) Radiation processed amniotic membranes in the treatment of non-healing ulcers of different etiologies. Cell Tissue Bank 5:129–134CrossRefPubMedGoogle Scholar
  23. Thames HD Jr, Withers HR, Peters LJ, Fletcher GH (1982) Changes in early and late radiation responses with altered dose fractionation: implications for dose-survival relationships. Int J Radiat Oncol Biol Phys 8(2):219–226Google Scholar
  24. Uludag M, Citgez B, Ozkaya O, et al. (2009) Effects of amniotic membrane on the healing of normal and high-risk colonic anastomoses in rats. Int J Color Dis. doi:10.1007/s00384-009-0691-5 Google Scholar
  25. Uludag M, Ozdilli K, Citgez B, Yetkin G, Ipcioglu OM, Ozcan O, et al. (2010) Covering the colon anastomoses with amniotic membrane prevents the negative effects of early intraperitoneal 5-FU administration on anastomotic healing. Int J Color Dis 25(2):223–232CrossRefGoogle Scholar
  26. Wellwood J, Jackson B (1973) The intestinal complications of radiotherapy. Br J Surg 60:814–818CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Mehdi Tahamtan
    • 1
  • Seyed Vahid Hosseini
    • 1
  • Hajar Khazraei
    • 1
  • Majid Forozesh
    • 1
  • Alimohammad Bananzadeh
    • 1
  • Maral Mokhtari
    • 1
  • Shahla Fereidooni
    • 1
  1. 1.Colorectal Research CenterShiraz University of Medical SciencesShirazIran

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