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Aim Anastomotic leak is the most feared complication of gastrointestinal surgery. Mesenchymal stem cell technology is used clinically to promote wound healing; however, the safety and efficacy of this technology on anastomotic healing has yet to be defined. The aim of this study was to investigate whether mesenchymal stem cells confer any benefit when applied to animal models for gastrointestinal anastomotic leak, identify the methodology and how efficacy is assessed. Methods The MEDLINE, EMBASE, WebofScience and Cochrane Library databases were interrogated between 1 January1947 to 1 May 2020. All studies where mesenchymal stem cells were applied to laboratory animal leak models to demonstrate a healing effect were considered. All experimental and histological outcomes were examined. Compliance to ARRIVE and current International Consensus was assessed. Results A total of 1205 studies were screened. Twelve studies reported on 438 gastrointestinal anastomoses in four species using 11 models; seven in the colon. No studies utilised a model with a known leak rate. Significant variance was observed in histological outcomes with efficacy demonstrated in five out of 12 studies. One study demonstrated a benefit in leak rate. Colorectal studies had a greater median ARRIVE compliance, 60.8% (IQR 63.2-64.5) compared to noncolorectal 45.4% (IQR 43.8-49.0). Conclusions Mesenchymal stem cell delivery to an animal anastomosis is safe and feasible. Use may confer benefit but findings are currently limited to surrogate histological outcomes. There is consistency in outcome measures reported but variance in how this is assessed. Poor compliance to ARRIVE but good compliance to current international consensus in leak models of the colon was observed.

Background Few studies have evaluated the role of computed tomography-guided percutaneous drainage (PD) in the management of gastrointestinal (GI) anastomotic leaks. Methods Ten-year review of an interventional radiology database identified patients with symptomatic GI anastomotic leaks. Clinical, laboratory, radiographic, and operative characteristics following a technically successful PD which then failed and required reoperation for anastomotic leak were compared with those successfully treated with PD. Results Sixty-one patients met study inclusion criteria. Fifty patients (82%) successfully underwent therapeutic PD of a perianastomotic fluid collection, with median follow-up of 16 months. Eleven patients (18%), at a median interval of 16 days, required reoperation following PD. A forward logistic regression showed cardiopulmonary disease ( P = .03) and cancer surgery ( P = .01) to be factors independently associated with the need for reoperation. The level of the anastomosis, initial fecal diversion/stoma, fluid collection size, and microbiology of aspirate did not predict failure of PD. Conclusions Cardiopulmonary disease and cancer surgery appear to be independent predictors for failure of PD and need for reoperation following a symptomatic GI anastomotic leak.

BACKGROUND: Few studies have evaluated the role of computed tomography-guided percutaneous drainage (PD) in the management of gastrointestinal (GI) anastomotic leaks. METHODS: Ten-year review of an interventional radiology database identified patients with symptomatic GI anastomotic leaks. Clinical, laboratory, radiographic, and operative characteristics following a technically successful PD which then failed and required reoperation for anastomotic leak were compared with those successfully treated with PD. RESULTS: Sixty-one patients met study inclusion criteria. Fifty patients (82%) successfully underwent therapeutic PD of a perianastomotic fluid collection, with median follow-up of 16 months. Eleven patients (18%), at a median interval of 16 days, required reoperation following PD. A forward logistic regression showed cardiopulmonary disease (P 5.03) and cancer surgery (P 5.01) to be factors independently associated with the need for reoperation. The level of the anastomosis, initial fecal diversion/ stoma, fluid collection size, and microbiology of aspirate did not predict failure of PD. CONCLUSIONS: Cardiopulmonary disease and cancer surgery appear to be independent predictors for failure of PD and need for reoperation following a symptomatic GI anastomotic leak.

Introduction: Anastomotic leak, although low in frequency (1–2%), is a dreaded complication after Roux-en-Y gastric bypass (GBP). Clinical uses of fibrin sealant for prevention of gastrointestinal (GI) leak have been reported; however, its efficacy has not been demonstrated. The aims of this study were to 1) develop an anastomotic leak animal model, 2) examine the efficacy of the tissue sealing property of fibrin sealant, and 3) review our experience in the use of fibrin sealant in 42 patients who underwent laparoscopic GBP. Methods: This study was performed in three phases. In phase 1, laparoscopic GI anastomosis was performed in adult swine with disruption of the staple-line starting at a 6F opening and sequentially increased in size until a leak model was developed. A leak model was developed at a 12F opening. In phase 2, ten animals (study group) underwent laparoscopic gastrojejunostomy with a 12F disruption of the anastomosis and received 2-mL of fibrin sealant (Tisseel, Baxter Healthcare Corp) applied on the disrupted area. The control animals (n = 6) did not receive the fibrin sealant. Animals were sacrificed on postoperative day 5 or earlier if peritonitis developed. The primary endpoint was sealing of the disrupted anastomosis at sacrifice and secondary endpoint was evaluation for the presence of intraabdominal abscess. In phase 3, fibrin sealant was used clinically in 42 laparoscopic GBP patients. Results: In phase 2, persistent anastomotic leak was identified in 2 of 6 control animals (both required early sacrifice due to peritonitis). Three of 6 control animals had intraabdominal abscess discovered at sacrifice on postoperative day 5 without persistent leak and 1 animal in the control group did not have any evidence of intraabdominal abscess or leak. Of the 10 animals in the study group, all survived until sacrifice. None of the animals had evidence of intraabdominal abscess or persistent leak at sacrifice. Leak or abscess occurred in 83% of control animals compared to 0% in the study animals (p < 0.01, Fischer’s Exact test). Clinically, there was no leak or intraabdominal abscess in the 42 patients who underwent laparoscopic GBP. Conclusions: The use of fibrin sealant in an animal leak model significantly reduces leak and abscess complication. Our results support the efficacy of tissue sealing property of fibrin sealant and its use on high-risk GI anastomosis.