Management of Postoperative Gastrointestinal Leakage With Autologous Stromal Vascular Fraction

Abstract

To assess the efficacy of using autologous stromal vascular fraction (SVF) to promote healing of controlled fistula tracts in the management of postoperative upper gastrointestinal leakage. This is an experimental study conducted on 10 experimental rabbits. Animal models were divided into the SVF group which received an autologous SVF and the control group which did not receive the implantation. Surgery was performed on both groups to induce a gastric leak and create a controlled fistula tract between the leakage site in the stomach and the skin. After 2 weeks, surgery was performed on the SVF group to harvest, process and then implant the autologous SVF in the fistula tract. Animal models were followed up and their fistula tracts were evaluated for healing by gross and microscopic examination of the fistula tracts before the SVF implantation and at 24 hours, 1 week, 2 weeks and 3 weeks after implantation. The control group revealed no closure of fistula tracts by the 3 rd week after implantation and there were no signs of inflammation or drainage. On the other hand, the SVF group showed signs of healing process with progressive closure of the fistula tract to about 95% by the 3 rd week after implantation. The use of autologous SVF implantation to promote

Clinical applications of adipose-derived stromal vascular fraction in veterinary practice

“…Furthermore, AdSVF appears promising in preventing gastrointestinal fistula tracts following gastrointestinal surgery, as demonstrated in rabbits (Aldaqal et al. 2015 ).…”

Regenerative medicine for digestive fistulae therapy: Benefits, challenges and promises of stem/stromal cells and emergent perspectives via their extracellular vesicles

“…The potential of stem/stromal cell therapy has also been studied in experimental models of enterocutaneous fistulae, this time as a curative treatment modality [97][98][99][100]. These experimental models, due to the absence of underlying pathology, were more representative of fistulae of postsurgical origin.…”

“…In another study, gastrocutaneous fistulae were created in rabbits by gastrotomy, and, after two hours for leakage formation, the insertion of a tube in the lesion as a drain. 2 weeks later, the drain was removed and autologous stromal vascular fraction (SVF, containing AdSCs) was injected into the fistula tract [98]. At 3 weeks post treatment, examination of the external openings and histological analysis of the fistula tract evidenced patent tracts with draining, inflamed external openings in the untreated control group and nearcomplete healing in the SVF group.…”

Local administration of stem cell-derived extracellular vesicles in a thermoresponsive hydrogel promotes a pro-healing effect in a rat model of colo-cutaneous post-surgical fistula

“…47,48 Although post-surgical fistulas were not listed as a therapeutic indication for Alofisel®, some papers have reported encouraging pre-clinical data based on the administration of AdSCs, associated or not with a biomaterial, for the management of digestive post-surgical complications. [49][50][51] A clinical trial on AdSC therapy for gastrointestinal post-surgical fistulas is ongoing by the Mayo Clinic (ClinicalTrials.gov identifier: NCT02807389). In this clinical investigation, cells are administered locally using a synthetic prosthesis biomaterial composed of polymers ( polyglycolic acid/trimethylene carbonate) that are gradually absorbed by the body.…”