The Efficacy and Safety of Using Collagen Patch on Anastomotic Site in Colorectal Surgery
Condition: Anastomosis, Functional
Study type: Observational

Summary: 
      In order to investigate the effects of collagen wound dressing on colonic anastomosis during
      colectomy, we conducted a retrospective cohort study. The goal of study was to determine
      whether the use of collagen wound dressing results in improving clinical outcomes for
      patients undergoing laparoscopic colectomy.
    

Detailed description: 
      Wound healing occurs in four distinct phases: hemostasis, inflammation, proliferation, and
      tissue remodeling. Numerous factors can influence these phases, which can be classified as
      either local or systemic. Local factors include infection, presence of foreign bodies,
      inadequate oxygenation, and other issues affecting the wound itself, while systemic factors
      encompass a wide range of considerations such as age, gender, presence of systemic disease,
      ischemia, stress, medication use, obesity, cigarette and alcohol use, nutritional status, and
      immunocompromised conditions.

      Anastomotic healing in the colon is similar to the healing process in skin while there's
      still some differences. While the cellular and histological processes involved in colonic
      healing are well known, the pathophysiological process is not fully understood and requires
      further studies . Unlike skin healing, the process of patients undergoing colonic resection
      and anastomosis healing can only be inferred by observing certain parameters, such as amount
      of drainage, time to first flatus and defecation and the patient's symptoms. These parameters
      are used to guide the patient's recovery program. Complications such as anastomotic leakage,
      bleeding or stricture would lead to longer hospital stay, mortality and morbidity. The most
      devastating one is anastomotic leakage. Although we have found some strategies to lower the
      rate in colorectal surgery such as colon preparation or antibiotics administration, the
      leakage still bothers a lot.

      Besides controlling the local and systemic factors, several biomaterial products have been
      designed to progress the healing. Collagen plays crucial roles in all of the four healing
      phases. As a result, collagen wound dressing, derived from bovine, equine, avian or porcine,
      has been applied in different sites of wound to promote healing. Several studies have
      concluded that collagen wound dressing resulted in better outcomes but limited to in vitro
      studies or animal based research. Pantelis D. concluded that fibrin in combination with the
      collagen patch can improve healing in high-risk mice that underwent colonic anastomosis
      surgery. Pommergaard HC. also concluded that the collagen wound dressing can lower the
      leakage rate in mouse colon anastomosis surgery.

      Another limitation is that most studies have small sample sizes and lack of long term
      observation. Parker et al designed a non-randomized study and concluded that collagen wound
      dressing is safe and easy to apply in human colorectal surgery. Marano et al compared the
      complication rate of two cohorts and revealed that collagen wound dressing can lower the
      complication rate in the patients who underwent upper gastrointestinal surgery. As of now, it
      is premature to conclude that collagen wound dressing is effective in human colonic
      anastomosis due to the lack of human studies and larger sample size. In order to investigate
      the effects of collagen wound dressing on colonic anastomosis during colectomy, we conducted
      a retrospective cohort study. Our goal was to determine whether the use of collagen wound
      dressing results in improving clinical outcomes for patients undergoing laparoscopic
      colectomy.
    

Intervention name(s): Laparoscopic colectomy
Intervention type(s): Procedure
Intervention description(s): Patients who under went laparoscopic colectomy
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Patients who underwent laparoscopic colectomy.