EP434 - Application of Human Amniotic Membrane to prevent anastomotic leaks in colorectal anastomosis

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Purpose/Background: Anastomotic leaks are amongst the most dreaded complications in colorectal surgery. The rate of leaks has been measured between 2% and 10% in all gastrointestinal surgery. With patients that have diminished wound healing, poor nutritional statuses, and have undergone neoadjuvant radiation therapy, the risk of anastomotic breakdown in colorectal cancer patients is elevated. Given the patient population who are at higher risk for anastomotic breakdown, the operator must be able to minimize blood loss, operative time, and gross contamination in order to maximize their chance for success anastomosis2. The development of human amniotic membrane as an additional surgeon adjunct to prevent breakdown has shown early success in decreasing the rate of leak3. The benefit of the amniotic membrane stems from its ability to promote epithelialization and wound healing while also minimizing inflammation and scarring.

Methods/Interventions: The patient is a 71 year old male with a strong family history of colorectal cancer who presented to the clinic with known rectosigmoid adenocarcinoma discovered on colonoscopy. Patient was known to have a significant smoking history of 27 pack years. The patient was diagnosed in 2019 with Stage II T3N0M0 rectal cancer and was treated with total neoadjuvant therapy with 8 cycles of FOLFOX. He was then transitioned to radiation therapy and Xeloda with complete response and underwent watch and wait surveillance. In 2023, he was found to have local recurrence and once again was placed on Xeloda after declining surgery. A sequence of MRIs showed interval increase in size of the PET avid lesion consistent with tumor invasion into the prostate. He then agreed to undergo Robotic assisted low anterior resection with colo-anal anastomosis with diverting loop ileostomy, partial prostatectomy, and splenic flexure takedown in spring 2024. During this initial procedure, the patient underwent an end to end hand sewn anastomosis 2 cm from the anal verge that was reinforced with an amniotic membrane. A diverting loop ileostomy was also performed during this index operation. The patient’s postoperative course was uncomplicated and the patient was discharged home on postoperative day 4. The patient eventually underwent ileostomy reversal several months later and was once again discharged on post-operative day 2 without complications.

Results/Outcomes: This 71 year old male with colorectal cancer and multiple risk factors for poor wound healing, including current smoker and recent pelvic radiation and chemotherapy, underwent robotic assisted low anterior resection with colo-anal anastomosis with the use of human amniotic membrane to aid in wound healing in the hopes of preventing anastomotic leak.

Conclusion/Discussion: After any gastrointestinal surgery requiring primary anastomosis, anastomotic breakdown is an unfortunate complication. Patients with colon cancer are amongst the highest risk for leak given advanced age, increased frailty, and neoadjuvant chemo and radiation therapy. The use of human amniotic membrane allows the surgeon an additional tool in their armamentarium to help prevent likelihood of an anastomotic leak.