Systematic Reviews
Copyright ©The Author(s) 2021.
World J Gastrointest Surg. Dec 27, 2021; 13(12): 1736-1753
Published online Dec 27, 2021. doi: 10.4240/wjgs.v13.i12.1736
Table 1 Basic characteristics of the included studies
Ref.
Country
Animal model (race)
Sample size (n)
Number of groups (n)
Animal per group (n)
Day at animal sacrification
Underlying animal condition that PRP was tested
PRP amount in anastomosis (and factors mixed with PRP)
Control
Primary comparison
Daglioglu et al[9], 2018TurkeyRat (Winstar-Albino)36312Day 7Normal0.5 mL PRPSimple end-end colon anastomosisPRP vs fibrin glue
Ocak et al[34], 2019TurkeyRat (Winstar-Albino)35310Day 7Hyperthermic intraperitoneal chemotherapy (HIPEC)200 μL PRP (200 μL thrombin and 100 μL calcium solution)Hyperthermic saline after anastomosisPRP vs non PRP application in rats having HIPEC with cisplatin
Yol et al[10], 2008TurkeyRat (Sprague Danwley)30310Day 7Normal1 mL PRP (0.1 mL thrombin and 1 mL calcium solution)Simple end-end colon anastomosisPRP vs bioglue
Buk et al[35], 2020TurkeyRat (Winstar-Albino)35310Day 7HIPEC1 mL PRP (1 mL thrombin and 0.5 mL calcium solution)Hyperthermic saline after anastomosisPRP vs non PRP application in rats having HIPEC with oxaliplatin
Dzhumabekov et al[25], 2019KazakhstanRabbit (Chinchillas)81327Day 7Normal0.2 mL/m2 PRPNormal saline injected in the muscular layer of end-end small bowel anastomosisPRP injection in bowel muscular layers vs soaking of bowel edges in PRP before anastomosis
Aydin et al[17], 2020TurkeyRat (Sprague Dawley)2438Day 7Normal0.7 μL PRP absorbed by suturesSimple end-end colon anastomosisHigher vs lower platelet concentration PRP-impregnated vicryl sutures
Dauser et al[26], 2020AustriaPig1644Day 0, 4, 10 and 30NormalPRF sprayEach group had one animal as a control: A simple anastomosis was performed with a circular staplerPRF vs no PRF application tested in several postoperative days
Giusto et al[28], 2017ItalyPig (Landace X Large White)824Day 8Normal1 mL PRP (50 μL calcium solution)2 out of 6 anastomoses performed in each animal used as a control anastomosis [no PRP or platelet rich in growth factors (PRGF) applied]PRP vs PRGF
Zhou et al[29], 2014ChinaRat (Sprague Dawley)30310Day 7Open abdomen. A polypropylene mesh used for abdomen closing in the open abdomen group1 mL PRPSimple end-end colon anastomosisPRP vs non PRP application in a background of open abdomen
Göksu et al[30], 2020TurkeyRat (Wistar Albino)2438Day 7HIPECPRP alone (dose not mentioned)Hyperthermic saline after anastomosisPRP vs non PRP application in rats having HIPEC with 5-fluorouracil (5-FU)
Özçay et al[16], 2018TurkeyRat (Sprague Dawley)40410Day 7Mesenteric ischemia/reperfusion injury (IR injury)PRF membrane applied around the anastomosisSimple end-end colon anastomosisPRF vs non PRF application following IR injury
Fresno et al[19], 2010SpainPig (White)3573 or 10Day 1, 2, 3, 4 and 7Normal1 mL PRP (50 μL calcium solution)1 out of 2 anastomoses performed in each animal used as a control anastomosis (no PRP or PRGF applied)PRP effect on several postoperative days
Daradka et al[27], 2019JordanRabbit (mixed-breed)30310Day 3 and 10NormalSutures submerged in 1 ml PRP solutionSimple end-end ileal anastomosisPRP vs sodium citrate coated sutures
Yalı et al[36], 2020TurkeyRat (Wistar-Albino)56412Day 5Peritonitis1 mL PRP (1 mL calcium solution)Simple end-end colon anastomosisPRP in normal abdomen vs peritonitis
Pehlivanli et al[33], 2019TurkeyRat (Wistar Albino)55510Day 10Mesenteric ischemia1 mL PRPSimple end-end colon anastomosisPRP vs Zeolite vs thymoquinone
Sozutek et al[31], 2016TurkeyRat (Wistar Albino)50410Day 7Peritonitis1 mL PRP (1 mL thrombin and 50 μL calcium solution)Simple end-end colon anastomosisPRP in normal abdomen vs peritonitis
Yamaguchi et al[18], 2012JapanRat (Sprague-Dawley)77412Day 5Normal180 μL PRP (180 units of bovine thrombin and 30 μL of calcium solution).Simple end-end colon anastomosisPlatelet poor plasma vs low vs high platelet rich plasma
Gorur et al[32], 2020TurkeyRat (Wistar Albino)50410Day 7Intraperitoneal administration of 5-FU1 mL PRP (1 mL thrombin and 50 μL of calcium solution)Simple end-end colon anastomosisPRP vs non PRP application in rats having intraperitoneal administration of 5-FU
Table 2 Anastomotic burst pressure, tissue hydroxyproline, collage deposition and inflammatory cell infiltration
Ref.
Anastomotic burst pressure (mm/hg)
Tissue hydroxyproline (μg/mg)
Collagen deposition
Inflammatory cells deposition
PRP
Control
Other agent
P value
PRP
Control
Other agent
P value
Daglioglu et al[9], 2018146 ± 44.55 mm/hg119 ± 35.65 mm/hg149.1 ± 72.29 mm/hg (Fibrin glue)vs Control (0.026); vs Fibrin glue (0.896)120.1 ± 51.5 μg/mg96.2 ± 29.22 μg/mg118.71 ± 42.18 μg/mgvs Control (0.023); vs Fibrin glue (0,745)No significant difference between groupsNo significant difference between groups
Ocak et al[34], 2019146 ± 21.85 mm/hg180 ± 9.14 mm/hg115.8 ± 18.19 mm/hg (HIPEC with cisplatin group)vs Control (< 0.001); vs HIPEC with cisplatin (0.01)256.59 ± 84.03 ng/mg314.69 ± 47.56 ng/mg148.02 ± 26.57 ng/mg (HIPEC with cisplatin)vs Control (0.335); vs Hyperthermic saline group (< 0.001)-Inflammatory cell infiltration is significant decreased with PRP application in HIPEC and cisplatin model
Yol et al[10], 2008270 ± 29.8 mm/hg195 ± 15.3 mm/hg214 ± 16.46 mm/hg (bioglue)vs Control (< 0.001); vs Bioglue (< 0.001)18.2 ± 4.95 μg/mg10.96 ± 5.94 μg/mg11.08 ± 5.08 μg/mgvs Control (0.016); vs Bioglue (0.026)Rich collagen production was observed in the PRP group. No comparison between groupsLess inflammatory cell infiltration in the PRP group
Buk et al[35], 2020125.7 ± 15.64 mm/hg180 ± 9.14 mm/hg94.90 ± 9.9 mm/hg (HIPEC with oxiliplatin)vs Control (< 0.001); vs HIPEC with oxiliplatin group (< 0.0011)280.92 ± 45.85 ng/mg314.69 ± 75.57 ng/mg92 ± 26.97 ng/mg (HIPEC with oxiliplatin)vs Control (< 0.001); vs HIPEC with oxiliplatin) (< 0.0011)-Inflammatory cell infiltration is significant decreased with PRP application in oxiplatin model
Dzhumabekov et al[25], 20191.76 ± 0.28 (PRP soakinggroup)11.54 ± 0.2311.81 ± 0.171 (PRP injecting group)vs Control (0.05); vs PRP injecting group (0.69)----No significant differences between groupsInflammatory cell infiltration significantly lower in the PRP soaking or injection group
Aydin et al[17], 2020121 ± 57 mm/hg124 ± 61 mm/hg180 ± 49 mm/hg (low concentration PRP)vs Control (> 0.05); vs low concentration PRP (< 0.0011)0.39 ± 0.10 μg/mg0.25 ± 0.17 μg/mg0.56 ± 0.37 μg/mg (low concentration PRP)vs Control (< 0.001); vs low concentration PRP (< 0.051)-No significant difference between groups
Dauser et al[26], 2020Median = 210 mm/hg (day 10)Median = 60 mm/hg (day 10)-The study reports no statistically significant changes between groups due to small sample size----Matrix treated animals showed less immature collagen deposition (type III) compared to the control group (day 10). However no significant differences were observedNo significant changes in the M2 or non-M2 macrophage density in the mucosal, mural and serosal layers. No significant changes in inflammatory cell infiltration
Giusto et al[28], 2017117.5 mm/hg (range: 80-190)154 mm/hg (range: 50-180)165 mm/hg (range: 100-190) (PRGF); And 175 mm/hg (range: 160-190) (intact bowel)vs Control or PRGF (> 0.05); vs Intact bowel (0.00071)----No significant difference between groupsNo significant difference between groups
Zhou et al[29], 2014177 ± 6.95 mm/hg184.8 ± 6.6 mm/hg158 ± 5.08 mm/hg (open abdomen group without PRP application)vs Control (0.398); vs non-PRP application in open abdomen (0.041)399.7 ± 9.46 μg/mg403.6 ± 8.55 μg/mg353.5 ± 6.75 μg/mg (open abdomen group without PRP application)vs Control (0.74); vs non-PRP application in open abdomen (0.001)Significantly higher in the PRP and control groupNo significant differences between groups
Göksu et al[30], 2020143 ± 17.35 mm/hg150 ± 20.49 mm/hg119.38 ± 17.65 mm/hg (5-FU HIPEC without PRP application)vs Control (0.718); vs non-PRP 5-FU HIPEC (0.047)253.64 ± 5.35 μg/mg259.6 ± 7.95 μg/mg244.04 ± 7.28 μg/mg (5-FU HIPEC without PRP application)vs Control (0.224); vs non-PRP 5-FU HIPEC (0.03)-Decreased lymphocytes in the PRP compared to the other groups. No statistically significant changes in neutrophil infiltration
Özçay et al[16], 2018198.1 ± 36.5 mm/hg205.1 ± 41.1 mm/hg106.1 ± 33.9 mm/hg (IR injury without PRF)vs Control (> 0.05); vs non PRF in IR injury (< 0.01)----Moderate to severe collagen deposition in all groups but no significant changes between groupsModerate to severe cellular infiltration but no significant changes between groups
Fresno et al[19], 20101.34 ± 0.07 kgf 1(day 3); 1.14 ± 0.11 kgf 1(day 7)1.21 ± 0.08 kgf 1(day 3); 1.08 ± 0.08 kgf 1(day 7)1.8 ± 0.08 kgf 1(normal tissue)vs Normal tissue (< 0.05); vs Control day 3 or 7 (> 0.05)----No significant difference between groups-
Daradka et al[27], 201960.2 ± 5.5 mm/hg54.5 ± 7.5 mm/hg55.6 ± 10.2 mm/hg (sodium citrate coated sutures)vs Control (0.211)0.76 ± 0.1 μg/mg0.47 ± 0.13 μg/mg0.52 ± 0.07 μg/mg (sodium citrate- coated sutures)vs Control (< 0.05) on day 10; vs Control (> 0.05) on day 3Statistically significant higher collagen deposition compared to uncoated suture groups on day 10Statistically significant less inflammatory infiltration compared to PRP uncoated suture groups
Yalı et al[36], 2020129.66 ± 26.6 mmH20143.25 ± 37.47 mmH20154.9 ± 27.64 mmH20 (colon anastomosis in peritonitis) and 173.5 ± 29.49 mmH20 (colon anastomosis and PRP application in peritonitis)vs Control (> 0.05); vs Colon anastomosis and PRP application in peritonitis (< 0.05)----Statistically significant higher collage storage values in PRP treated group compared to control and peritonitis modelStatistically significant differences between groups in terms of inflammatory reaction
Pehlivanli et al[33], 2019225 (range: 180-250)2200 (range: 90-230)2235 (range: 220-250)2 thymoquinone; 132.5 (range: 85-150)2 Zeolitevs Control (> 0.05); vs Zeolite (< 0.05); vs Thymoquinone (> 0.05)613.22 (range: 158.55-801.82)2371.27 (range: 164.51-785.45)2473.03 (range: 215.33-963.43)2 thymoquinone; 459.15 (range: 182.44-738.21)2 Zeolitevs Control (> 0.05); vs Zeolite (> 0.05); vs Thymoquinone (> 0.05)-No significant difference in terms of inflammation at the anastomotic line in between groups
Sozutek et al[31], 2016209 ± 14.4 mm/hg179.5 ± 10.3 mm/hg129.3 ± 14.2 mm/hg (colon anastomosis in peritonitis); 167.5 ± 7.5 mm/hg (colon anastomosis and PRP application in peritonitis)vs Control (0.01); vs Colon anastomosis in peritonitis (0.01); vs Colon anastomosis and PRP application in peritonitis (0.01)17.4± 1.21 μg/mg10.8± 0.67 μg/mg8.98 ± 1.04 μg/mg (colon anastomosis in peritonitis); 10.6 ± 0.52 μg/mg (colon anastomosis and PRP application in peritonitis)vs Control (0.023); vs Colon anastomosis in peritonitis (0.01); vs Colon anastomosis and PRP application in peritonitis (0.012)Application of PRP in peritonitis group did no increase collagen deposition significantlyMacrophages significantly increased in PRP vs control group and lymphocytes were significantly decreased in PRP + peritonitis compared to peritonitis group
Yamaguchi et al[18], 2012148 ± 25 mm/hg (H-PRP)171 ± 20 mm/hg174 ± 23 mm/hg (PPP); 189 ± 17 mm/hg (L-PRP)vs Control (< 0.05); vs L-PRP (< 0.05); vs PPP (< 0.05)407 ± 143 μg/mg515 ± 130 μg/mg495 ± 123 μg/mg (PPP); 629 ± 120 μg/mg (L-PRP)vs Control (< 0.05); vs L-PRP (< 0.05); vs PPP (< 0.05)In L-PRP more collagen deposition in the serosa layer compared to other groups. H-PRP showed the lesser collagen deposition compared to other groups-
Gorur et al[32], 2020246.7± 25.1 mm/hg232.6± 19.5 mm/hg127.5± 17.7 mm/hg (colon anastomosis and 5-FU intraperitoneal); 202.9 ± 28.8 mm/hg (colon anastomosis + PRP and 5-FU intraperitoneal)vs Control (> 0.05); vs Colon anastomosis and 5-FU intraperitoneal (< 0.05); Colon anastomosis + PRP vs non PRP and 5-FU intraperitoneal (< 0.05)1939.5 ± 586 μg/mg2994.6 ± 2132.4 μg/mg591 ± 84.4 μg/mg (colon anastomosis and 5-FU intraperitoneal); 1171 ± 301.7 μg/mg (colon anastomosis + PRP and 5-FU intraperitoneal)vs Control (0.212); vs Colon anastomosis and 5-FU intraperitoneal (< 0.05); Colon anastomosis + PRP vs non PRP and 5-FU intraperitoneal (< 0.05)Increased but no statistically significant collagen deposition in colon anastomosis + PRP vs non PRP on a background of intraperitoneal 5-FU administrationNo significant differences between groups
Table 3 Verhofstad histopathology scale
Groups
Necrosis
Neutrophil
Lymphocyte
Macrophages
Oedema
Mucosal epithelium
Submucosal layer
Bridging
Total
Ocak et al[34]
Control2.3 ± 0.822.5 ± 0.522.5 ± 0.522.5 ± 0.522.9 ± 0.312.6 ± 0.9660.8 ± 0.63--
PRP2.6 ± 0.692.8 ± 0.42a2.7 ± 0.48a2.7 ± 0.48a2.9 ± 0.312.6 ± 0.5161.4 ± 0.69--
Fibrin glue2 ± 0.662.1 ± 0.31a2.1 ± 0.31a2.1 ± 0.31a2 ± 0.472.6 ± 0.5161.3 ± 0.67--
Buk et al[35]
Control2.3 ± 0.821.9 ± 0.56a1.8 ± 0.42a2 ± 0.472.1 ± 0.56a2.6 ± 0.9660.8 ± 0.63a--
Oxaliplatin2.5 ± 0.522.9 ± 0.52a2.4 ± 0.51a2.5 ± 0.522.8 ± 0.42a2.6 ± 0.5162 ± 0.94a--
Oxaliplatin + PRP2.7 ± 0.582 ± 0.47a1.8 ± 0.42a2.3 ± 0.672.1 ± 0.56a2.5 ± 0.541.6 ± 0.96a--
Aydin et al[17]
Control1 ± 12 ± 1-2 ± 02 ± 13 ± 13 ± 0--
L-PRP0 ± 22 ± 1-2 ± 01 ± 0a2.5 ± 1a3 ± 2--
H-PRP1.5 ± 22 ± 2-2 ± 10 ± 0a1 ± 2a3 ± 0--
Göksu et al[30]
Control2.38 ± 0.512.38 ± 0.5182.38 ± 0.51a-2.75 ± 0.46a2.63 ± 0.511.75 ± 0.46--
5-FU2.63 ± 0.512.50 ± 0.4632.63 ± 0.51a-2.75 ± 0.46a2.50 ± 0.531.25 ± 0.46--
5-FU + PRP2.13 ± 0.352.13 ± 0.5182 ± 1a-2 ± 0.53a2.63 ± 0.511.25 ± 0.46--
Sozutek et al[31]
Control0.3 ± 0.481.3 ± 0.941 ± 0.471 ± 0a0.4 ± 0.510.3 ± 0.48-0.6 ± 0.514.9 ± 1.28
Control + PRP0.2 ± 0.420.7 ± 0.671 ± 0.471.6 ± 0.51a0.3 ± 0.480.4 ± 0.48-0.2 ± 0.424.3 ± 1.33
Septic1.1 ± 0.641.5 ± 0.531.6 ± 0.51a1.1 ± 0.831.2 ± 0.71a1 ± 0.53-1.2 ± 0.719.8 ± 1.12a
Septic + PRP0.7± 0.481.2 ± 0.421.3 ± 0.48a1.5 ± 0.520.4 ± 0.51a0.5 ± 0.51-0.8 ± 0.426.1 ± 1.37a
Gorur et al[32]
Control0.3 ± 0.67a1.3 ± 0.91 ± 0.471 ± 01.1 ± 0.31a0.3 ± 0.57a-1.2 ± 0.78a-
5-FU1 ± 1.05a1.5 ± 0.531.4 ± 0.321.1 ± 0.832 ± 0.73a1.1 ± 0.42a-1.5 ± 0.52a-
Control + PRP0a0.7 ± 0.671 ± 0.671.8 ± 0.311 ± 0.47a0.3 ± 0.57a-0.9 ± 0.87a-
5-FU + PRP0.1 ± 0.31.2 ± 0.421.5 ± 0.581.6 ± 0.531.7 ± 0.480.6 ± 0.57-1.1 ± 0.31-