Evaluation of repair in duodenal perforation with human amniotic membrane: An animal model (dog)

Abstract

Background:There is a growing tendency toward application of human amniotic membrane (HAM) as a biologic substitute in various tissue injuries where a significant tissue loss is a matter of concern. In gastrointestinal injuries especially duodenal ones, some potential limitations in current surgical techniques contribute to not fully acceptable healing outcomes. Thus, this study was carried out to assess repair with HAM patch for duodenal defect in comparison with simple duodenoraphy in an animal model (dog).Materials and Methods:A total of 15 male German shepherd dogs weighing 23-27 kg were randomly divided into two groups. Group A with 10 dogs, which were a candidate for duodenal repair by amniotic membrane patch and Group B consisted of 5 dogs perform simple duodenorraphy. A precise control was made to match all conditions except surgical technique. Macroscopic and microscopic features of the healed duodenal lumen in both groups were recorded.Results:Gross evaluation revealed no difference in luminal diameter in both groups. Statistical analysis of duodenal diameter between both groups after operation also showed no significant difference (Pv = 0.789). Histological assessment indicated less inflammation with better wound healing in Group A.Conclusion:It seems that repairing duodenal wall defect with HAM would result in better histological outcomes compared with what is seen in simple duodenoraphy in animal models. However, there is no significant difference regarding surgical findings.

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 ; ...…”

“…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 ).…”

“…No MA could be conducted with the two other studies due to missing data. The average duration until complete epithelialization ranged between 4 and 11 weeks (Table S5 ) (Fishman et al., 1987 ; Ghahramani et al., 2014 ; Güneş et al., 2016 , 2017 ; Ismail, Marcos, et al., 2009 ; Kesting et al., 2010 ; Li et al., 2019 ; Moslemi et al., 2016 ; Rohleder et al., 2013 ; Tsuda et al., 1999 ). The quality of the epithelialization and the time to complete epithelialization compared to control were not assessed in the included studies.…”