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. 2015 Apr;100(4):748-54.
doi: 10.9738/INTSURG-D-14-00120.1.

Management of postoperative gastrointestinal leakage with autologous stromal vascular fraction

Saleh M Aldaqal  1 , Meiaad F Khayat, Rana Y Bokhary, Mazen M Wakka, Adnan A Merdad, Leena A Merdad
Affiliations

Management of postoperative gastrointestinal leakage with autologous stromal vascular fraction

Saleh M Aldaqal et al. Int Surg. 2015 Apr.

Abstract

To assess the efficacy of using autologous stromal vascular fraction (SVF) to promote healing of controlled fistula tracts in the management of postoperative upper gastrointestinal leakage. This is an experimental study conducted on 10 experimental rabbits. Animal models were divided into the SVF group which received an autologous SVF and the control group which did not receive the implantation. Surgery was performed on both groups to induce a gastric leak and create a controlled fistula tract between the leakage site in the stomach and the skin. After 2 weeks, surgery was performed on the SVF group to harvest, process and then implant the autologous SVF in the fistula tract. Animal models were followed up and their fistula tracts were evaluated for healing by gross and microscopic examination of the fistula tracts before the SVF implantation and at 24 hours, 1 week, 2 weeks and 3 weeks after implantation. The control group revealed no closure of fistula tracts by the 3(rd) week after implantation and there were no signs of inflammation or drainage. On the other hand, the SVF group showed signs of healing process with progressive closure of the fistula tract to about 95% by the 3(rd) week after implantation. The use of autologous SVF implantation to promote the healing of controlled fistula tracts seems to be a novel, safe and effective method in the management of postoperative upper gastrointestinal leakage. It could prevent reoperation and reduce hospital stay, morbidity and mortality. These results are promising and provide support for further clinical studies.

Keywords: Adipose stem cells; Gastrointestinal leakage; Postoperative leakage; SVF; Stromal vascular fraction.

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Figures

Fig. 1
Fig. 1
The tube was inserted into the leakage site in the stomach and fixated.
Fig. 2
Fig. 2
Harvesting inguinal adipose tissue.
Fig. 3
Fig. 3
Processing adipose tissue.
Fig. 4
Fig. 4
Implanting the adipose stem cells in the fistula tract.
Fig. 5
Fig. 5
Excised fistula tract for histopathology examination.
Fig. 6
Fig. 6
Gross examination of tract external openings at 24 hours and 1, 2, and 3 weeks after implantation. Comparison of the percentage of animal models with tract closure, drainage, and inflammation of the skin around the opening between the stem cell group and control group.
Fig. 7
Fig. 7
Microscopic examination of tract external openings at 24 hours and 1, 2, and 3 weeks after implantation. Comparison of the average percentage of tract closure and the percentage of animal models with healing (granulation tissue) and inflammation (inflammatory cells) between the stem cell group and control group.
Fig. 8
Fig. 8
Control fistula tract (3rd week): the lumen is patent and the wall is formed of granulation tissue (hematoxylin and eosin stain, ×4).
Fig. 9
Fig. 9
Fistula tract implanted with adipose stem cells (3rd week): overview showing distended lumen filled with different types of cells.
See this image and copyright information in PMC

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