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Photochemical Tissue Bonding Improves Colonic Anastomotic Strength
Objective: Colonic anastomotic leak is a potentially devastating surgical complication resulting from decreased anastomotic strength during the early postoperative period. Photochemical Tissue Bonding (PTB) is a novel tissue repair technique that combines a photoactive dye (rose bengal) with visible light to create immediate fluid-tight seals between tissue surfaces. Our objective was to determine whether an amniotic membrane sealed by PTB over a colonic anastomosis improves repair strength compared to standard suturing.
Design: Controlled in vivo animal study
Setting: University Hospital Research Laboratory
Interventions: Sprague Dawley rats (n= 60) underwent a 4 cm midline laparotomy. A 5 mm segment of the left colon was resected and an end-to-end anastomosis performed for each experimental group: 1) Standard anastomosis with running sutures, 2) standard anastomosis+ sutured amnion wrap, 3) standard anastomosis+ PTB amnion wrap.
Outcome Measures: Evaluation was done at 3 and 7 days postoperatively using: 1) Gross appearance, 2) Burst anastomotic pressure and 3) Histologic evaluation.
Results: The PTB amnion-sealed anastomosis group demonstrated higher burst pressures (94±25 mm Hg) on day 3 compared to the standard (25±9 mmHg, p<.001) and sutured amnion (29±18 mm Hg, p<.001) anastomosis groups. On day 7, there was little difference between groups. Adhesion formation was markedly reduced in PTB amnion and sutured amnion groups (no to minimal adhesion) compared to the standard repair (moderate to severe adhesion with bowel and omentum) at 3 and 7 days.
Conclusions: A PTB-sealed amnion wrap improves the early anastomotic strength, while reducing perianastomotic adhesions. Its use should be explored to reduce anastomotic leaks and adhesion-related complications.