Evaluating The Therapeutic Potential of Platelet-Rich Plasma in Enhancing Bowel Anastomotic Healing: An Experimental and Clinical Investigation in Humans
Keywords:
anastomotic leak, colorectal surgery, platelet-rich plasma, autologous fibrin matrix, burst pressure, wound healingAbstract
Background: Anastomotic leak (AL) remains the most feared complication after colorectal resection, with rates of 4 – 20 % and a 10-fold increase in 30-day mortality. Platelet-rich plasma (PRP) is an autologous concentrate of platelets, cytokines and growth factors that accelerates soft-tissue healing; its role at the gastrointestinal anastomosis is incompletely defined .
Methods: We performed a prospective, single-blind, parallel-group study that integrated (i) an experimental arm in 16 elective rectal‐resection patients undergoing a temporary diverting loop ileostomy and (ii) a clinical superiority trial in 60 elective colonic‐resection patients (30 PRP; 30 controls). PRP was prepared intra-operatively from 120 mL of autologous blood (Vivostat® system) and sprayed circumferentially onto a stapled, tension-free colorectal or ileocolic anastomosis. Primary outcomes were anastomotic burst pressure (ABP) on postoperative day (POD) 3, 7 and 14 (stoma patients) and clinical AL within 30 days (all patients). Secondary endpoints included C-reactive protein kinetics, time to diet, length of stay and 90-day morbidity.
Results: Mean ABP was significantly higher in the PRP cohort at each time point (P < 0.001) (Figure 1). In the clinical trial, PRP reduced AL from 23.3 % to 6.7 % (risk ratio 0.29, 95 % CI 0.07-0.98; P = 0.037) (Figure 2) and shortened median length of stay by 3 days. Multivariable analysis confirmed PRP application as an independent protective factor (adjusted OR 0.21, 95 % CI 0.05-0.91). There were no device-related adverse events.
Conclusion: Autologous PRP significantly reinforces early anastomotic integrity and translates into a clinically meaningful reduction in leak rate. Larger multicentre trials (e.g., NCT05174910) are warranted to confirm these findings..
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