Geropoulos G, Psarras K, Giannis D, Martzivanou EC, Papaioannou M, Kakos CD, Pavlidis ET, Symeonidis N, Koliakos G, Pavlidis TE. Platelet rich plasma effectiveness in bowel anastomoses: A systematic review. World J Gastrointest Surg 2021; 13(12): 1736-1753 [PMID: 35070077 DOI: 10.4240/wjgs.v13.i12.1736]
Corresponding Author of This Article
Dimitrios Giannis, MD, MSc, Doctor, Postdoctoral Fellow, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, United States. dgiannis@northwell.edu
Research Domain of This Article
Surgery
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Georgios Geropoulos, Department of General Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
Georgios Geropoulos, Kyriakos Psarras, Eirini Chrysovalantou Martzivanou, Efstathios Theodoros Pavlidis, Nikolaos Symeonidis, Theodoros Efstathios Pavlidis, Laboratory of Scientific Research and Experimental Surgery, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
Georgios Geropoulos, Christos Dimitrios Kakos, Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
Dimitrios Giannis, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Manhasset, NY 11030, United States
Maria Papaioannou, Georgios Koliakos, Laboratory of Biological Chemistry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki 54124, Greece
Author contributions: Geropoulos G, Psarras K and Giannis D equally contributed to this study; Geropoulos G, Giannis D and Psarras K designed the research; Papaioanou M, Martzivanou EC and Kakos CD performed the research; Geropoulos G, Giannis D, Psarras K and Papaioanou M wrote the paper; Martzivanou EC, Pavlidis ET and Symeonidis N analyzed the data; Koliakos G and Pavlidis TE supervised the paper; all authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declared no potential conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dimitrios Giannis, MD, MSc, Doctor, Postdoctoral Fellow, Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, United States. dgiannis@northwell.edu
Received: April 19, 2021 Peer-review started: April 19, 2021 First decision: July 27, 2021 Revised: August 11, 2021 Accepted: November 18, 2021 Article in press: November 18, 2021 Published online: December 27, 2021 Processing time: 249 Days and 0.8 Hours
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.
Core Tip: The positive effect of platelet rich plasma (PRP) in bowel anastomoses has been shown by several studies. The application of PRP in bowel anastomoses in the presence of impaired wound healing conditions like ischemia, infection or chemotherapy significantly improved anastomosis burst pressure and tissue hydroxyproline, two of the most common used parameters to test anastomosis integrity. The current literature supports the effectiveness of PRP in animal models. Further studies are needed in order to determine the potential role of PRP in clinical practice.
