Platelet rich plasma effectiveness in bowel anastomoses: A systematic review

Abstract

BACKGROUND Anastomotic leak constitutes a major problem in abdominal surgery. Technical insufficiency, topical or systemic factors contribute to disrupted healing of the performed bowel anastomosis and result in anastomosis leakage, with detrimental effects on patient postoperative outcomes. Despite the investigation of several factors and the invention of protective materials, the ideal agent to prevent anastomotic leaks is yet to be determined. AIM To study the effect of platelet rich plasma (PRP) on the healing of bowel anastomoses. METHODS A systematic literature search was performed in PubMed, EMBASE, and Scopus databases to identify studies investigating the effect of PRP application on bowel anastomosis. RESULTS Eighteen studies were eligible with a total population of 712 animals including rats (14 studies), rabbits (2 studies) and pigs (2 studies). No postoperative complications were reported following PRP application. Fourteen out of 18 studies reported a statistically significant higher anastomosis bursting pressure in PRP groups compared to control either in healthy animals or animal models with underlying condition or intervention, such as intraperitoneal chemotherapy or peritonitis. Similar results were reported by ten studies in terms of tissue hydroxyproline levels. One study reported significant increase in collagen deposition in PRP groups. PRP application resulted in significantly decreased inflammatory cell infiltration in the presence of peritonitis or intraperitoneal chemotherapy (6 studies). CONCLUSION The application of PRP is associated with improved bowel anastomosis outcomes, especially in animal models having an underlying condition affecting the normal healing process. PRP application seems to augment the normal healing process under these circumstances. However, further studies are needed to investigate the potential role of PRP on bowel anastomosis healing, especially in clinical settings.

The Effectiveness of Adipose Tissue-Derived Mesenchymal Stem Cells Mixed with Platelet-Rich Plasma in the Healing of Inflammatory Bowel Anastomoses: A Pre-Clinical Study in Rats

“…Their results indicate that PRP is safe to administer and provides a significant benefit in animals with peritonitis or post-intraperitoneal chemotherapy application. However, compared with normal controls, PRP did not provide any significant benefit over the bowel anastomosis healing process [18]. These findings are keeping in line with our results where the PRP+MSCs group provided a significant benefit in bowel anastomosis healing over the colitis control group, however when compared with normal controls, no significant changes were observed.…”

“…Other studies investigating the combination of PRP and MSCs (PRP+MSCs) have demonstrated that VEGF facilitates MSCs' angiogenic properties and enhances the wound healing process. Finally, fibroblast mitogenic activity is improved by the presence of IGF, which is secreted by PRP [18].…”

Clinical results after external reinforcement of colorectal anastomosis: a systematic review

“…In 2021, Geropoulos 72 described in his systematic review and meta-analysis about 18 animal studies using PRP on bowel anastomosis that its application shows improved outcomes in terms of anastomoses bursting pressure and tissue hydroxyproline.…”

P-Selectin is a Critical Factor for Platelet-Mediated Protection on Restraint Stress-Induced Gastrointestinal Injury in Mice

“…Purified platelets and PRP are tissue regenerative agents; injections of a concentration of a patient’s own platelets can accelerate the healing of injured tendons, ligaments, muscles and joints [ 17 , 24 , 26 , 27 , 28 ]. In GI tissue repair, PRP exerts beneficial effects in intestinal anastomosis animal models [ 29 , 30 , 31 , 32 ]. At the same time, PRP accelerated epithelialization and healing in patients with chronic anal fissures [ 33 ].…”