title: A light-activated amnion wrap strengthens colonic anastomosis and reduces peri-anastomotic adhesions.
abstract: Colonic anastomotic failure is a dreaded complication, and multiple surgical techniques have failed to eliminate it. Photochemical tissue bonding (PTB) is a method of sealing tissue surfaces by light-activated crosslinking. We evaluated if a human amniotic membrane (HAM), sealed over the anastomotic line by PTB, increases the anastomotic strength.
  
  
  
  Sprague-Dawley rats underwent midline laparotomy followed by surgical transection of the left colon. Animals were randomized to colonic anastomosis by one of the following methods (20 per group): single-layer continuous circumferential suture repair (SR); SR with a HAM wrap attached by suture (SR+ HAM-S); SR with HAM bonded photochemically over the anastomotic site using 532 nm light (SR+ HAM-PTB); approximation of the bowel ends with only three sutures and sealing with HAM-PTB (3+ HAM-PTB). A control group underwent laparotomy alone with no colon resection (NR). Sub-groups (n = 10) were sacrificed at days 3 and 7 post-operatively and adhesions were evaluated. A 6 cm section of colon was then removed and strength of anastomosis evaluated by burst pressure (BP) measurement.
  
  
  
  A fourfold increase in BP was observed in the SR+ HAM-PTB group compared to suture repair alone (94 ± 3 vs. 25 ± 8 mm Hg, P < 0.0001) at day 3. At day 7 the burst pressures were 165 ± 40 and 145 ± 31 mm Hg (P = 1), respectively. A significant decrease in peri-anastomotic adhesions was observed in the SR+ HAM-PTB group compared to the SR group at both time points (P < 0.001).
  
  
  
  Sealing sutured colonic anastomotic lines with HAM-PTB increases the early strength of the repair and reduces peri-anastomotic adhesions. Lasers Surg. Med. 48:530-537, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, 02114.|Plastic Surgery Research Laboratory, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: Prabhu
authors.initials: P
authors.lastname: Senthil-Kumar
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, 02114.|Department of Burns and Plastic Surgery, No. 3 People's Hospital, and Institute of Traumatic Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, 201900, P.R. China.
authors.forename: Tao
authors.initials: T
authors.lastname: Ni
authors.affiliation: Plastic Surgery Research Laboratory, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Randolph
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: George C
authors.initials: GC
authors.lastname: Velmahos
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: Irene E
authors.initials: IE
authors.lastname: Kochevar
authors.affiliation: Wellman Center for Photomedicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, 02114.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Redmond
mesh_terms: D000650:Amnion / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D000818:Animals; D003106:Colon / Q000601:surgery*; D006801:Humans; D010778:Photochemotherapy / Q000379:methods*; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D058106:Wound Closure Techniques
keywords: amnion; anastomosis; anastomotic leak; colon; crosslinking; photochemistry; rose bengal