spracticeХирургическая практикаSurgical practice (Russia)2223-2427АНО "Консорциум "Медицинская техника"10.38181/2223-2427-2022-2-84-92spractice-312Research ArticleСтатьиПРИМЕНЕНИЕ СИСТЕМЫ VIVOSTAT® КАК МЕТОДА ПРОФИЛАКТИКИ НЕСОСТОЯТЕЛЬНОСТИ АНАСТОМОЗА ПОСЛЕ НИЗКОЙ ПЕРЕДНЕЙ РЕЗЕКЦИИ ПРЯМОЙ КИШКИ. КЛИНИЧЕСКИЙ СЛУЧАЙVIVOSTAT ® SYSTEM AS A METHOD OF PREVENTING ANASTOMOTIC LEAKAGE FOLLOWING LOW ANTERIOR RECTAL RESECTION: CLINICAL CASEhttps://orcid.org/0000-0002-6569-7078АгаповМ. А.AgapovM. A.

Агапов Михаил Андреевич – д.м.н., профессор, профессор кафедры хирургии

ул. Ленинские Горы, д. 1, 119991, Москва

Mikhail A. Agapov – PhD, Professor of the Department of Surgery

Moscow 

getinfo911@mail.ruhttps://orcid.org/0000-0003-2711-2400МаркарьянД. Р.MarkaryanD. R.

Маркарьян Даниил Рафаэлевич – кандидат мед. наук, доцент кафедры хирургии

ул. Ленинские Горы, д. 1, 119991, Москва

Daniil R. Markaryan – PhD, docent of the Department of Surgery

Moscow 

dmarkaryan@gmail.comhttps://orcid.org/0000-0003-2330-4229ГармановаТ. Н.GarmanovaT. N.

Гарманова Татьяна Николаевна – кандидат мед. наук, доцент кафедры хирургии

ул. Ленинские Горы, д. 1, 119991, Москва

Tatyana N. Garmanova – PhD, docent of the Department of Surgery

Moscow 

tatianagarmanova@gmail.comhttps://orcid.org/0000-0001-6322-7016КазаченкоЕ. А.KazachenkoE. A.

Казаченко Екатерина Александровна – врач-ординатор 1 года отделения хирургии №1 медицинского научно-образовательного центра МГУ

ул. Ленинские Горы, д. 1, 119991, Москва

Ekaterina A. Kazachenko – Resident of the Department of Surgery №1 of the Medical Research Educational Center

Moscow 

ekaterina.k.97@mail.ruhttps://orcid.org/0000-0001-8186-190XЦимайлоИ. В.TsimailoI. V.

Цимайло Иван Владимирович – врач-ординатор отделения хирургии №1 медицинского научно-образовательного центра МГУ

ул. Ленинские Горы, д. 1, 119991, Москва

Ivan V. Tsimailo – Resident of the Department of Surgery №1 of the Medical Research Educational Center

Moscow 

tsismailo17@gmail.comhttps://orcid.org/0000-0003-0352-2317КакоткинВ. В.KakotkinV. V.

Какоткин Виктор Викторович – врач-хирург, отделения хирургии №1 медицинского научно-образовательного центра МГУ

119192, Москва, Ломоносовский проспект, д. 27, корп. 10

Viktor V. Kakotkin – Surgeon of the Department of Surgery №1 of the Medical Research Educational Center

Moscow 

axtroz4894@gmail.comМосковский государственный университет имени М.В. Ломоносова, факультет фундаментальной медицины (МГУ имени М.В. Ломоносова)РоссияFederal State Budget Educational Institution of Higher Education M.V. Lomonosov Moscow State University (Lomonosov MSU)Russian Federation202225062022028492Copyright © Агапов М.А., Маркарьян Д.Р., Гарманова Т.Н., Казаченко Е.А., Цимайло И.В., Какоткин В.В., 20222022Агапов М.А., Маркарьян Д.Р., Гарманова Т.Н., Казаченко Е.А., Цимайло И.В., Какоткин В.В.Agapov M.A., Markaryan D.R., Garmanova T.N., Kazachenko E.A., Tsimailo I.V., Kakotkin V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.spractice.ru/jour/article/view/312Введение

Введение: По данным современной литературы несостоятельность анастомоза занимает лидирующие позиции среди всех осложнений колоректальной хирургии. Отдельным направлением профилактики данного осложнения в колоректальной онкологии является изучение возможностей применения биологических клеевых смесей в качестве универсального биологического и механического барьера на пути распространения внутрипросветной микрофлоры и опухолевых клеток.

Клинический случай

Клинический случай: Пациентка 65 лет госпитализирована с диагнозом рак среднеампулярного отдела прямой кишки сT3сN1сM0 III стадии после проведения неоадъвантного химиолучевого лечения. Проведено хирургическое лечение в объеме лапароскопической низкой передней резекции прямой кишки с расширенной лимфодиссекцией, выведением протективной илеостомы. Анастомоз был сформирован на высоте 4 см от ануса. Интраоперационно выполнено укрепление линии анастомоза с помощью продукта системы VivostatR. Технология изготовления и применения смеси описана в работе. Послеоперационный период протекал без осложнений.

Выводы

Выводы: Вследствие возможных экономических, онкологических и послеоперационных преимуществ применение современных фибриновых клеевых композиций является достаточно перспективным для внедрения в хирургическую практику. Требуется проведение исследований, направленных на изучение эффективности данного способа профилактики несостоятельности колоректальных анастомозов.

Background

Background: According to current literature, anastomosis leakage holds a leading position among all complications of colorectal surgery. A particular area of prevention of this complication in colorectal oncology is the research of the possibilities of using biological adhesive compounds as a universal biological and mechanical barrier to the spread of intraluminal microflora and tumor cells.

Clinical case

Clinical case: A 65-year-old patient (female) was hospitalized with a diagnosis of rectal cancer cT3cN1cM0 (stage III) after neoadjuvant chemoradiotherapy. Surgical treatment was performed: the laparoscopic low anterior resection of the rectum with expanded lymphodissection, protective loop ileostomy. The anastomosis was formed at a height of 4 cm from the anus. Intraoperatively, the anastomosis line was strengthened using the Vivostat R system product. The technology of on-site preparation and application of the compound is described in the paper.. The postoperative period passed without complications.

Conclusion

Conclusion: Due to the possible economic, oncological and postoperative advantages, the use of modern fibrin adhesive compositions is quite promising for introduction into surgical practice. It is required to conduct research aimed at studying the effectiveness of this method of preventing the leakage of colorectal anastomoses.

Vivostat ®фибриновый клейнесостоятельность анастомозапослеоперационные осложнениянизкая передняя резекция прямой кишкирак прямой кишки.Vivostat ® systemfibrin glueanastomotic leakagepostoperative complicationslow anterior rectal resectionrectal cancerReferencesФедеральная служба государственной статистики (Росстат). Здравоохранение в России 2021г. Статистический сборник, 173 с., 2021, Online. Available: https://rosstat.gov.ru/storage/mediabank/Zdravoohran-2021.pdf.Federalnaya sluzhba gosudarstvennoj statistiki (Rosstat). Zdravoohranenie v Rossii 2021g. Statisticheskij sbornik, 173 p, 2021. (In Russian) Online. Available: https://rosstat.gov.ru/storage/mediabank/Zdravoohran-2021.pdf.P. Fransvea, G. Costa, L. D’Agostino, G. Sganga, and A. Serao, Redo-laparoscopy in the management of complications after laparoscopic colorectal surgery: a systematic review and meta-analysis of surgical outcomes, Techniques in Coloproctology, vol. 25, no. 4. 2021, https://doi.org/10.1007/s10151-020-02374-8P. Fransvea, G. Costa, L. D’Agostino, G. Sganga, and A. Serao, Redo-laparoscopy in the management of complications after laparoscopic colorectal surgery: a systematic review and meta-analysis of surgical outcomes, Techniques in Coloproctology, vol. 25, no. 4. 2021, https://doi.org/10.1007/s10151-020-02374-8C. Foppa, S. C. Ng, M. Montorsi, and A. Spinelli. Anastomotic leak in colorectal cancer patients: New insights and perspectives. European Journal of Surgical Oncology, vol. 46, no. 6. 2020, https://doi.org/10.1016/j.ejso.2020.02.027C. Foppa, S. C. Ng, M. Montorsi, and A. Spinelli. Anastomotic leak in colorectal cancer patients: New insights and perspectives. European Journal of Surgical Oncology, vol. 46, no. 6. 2020, https://doi.org/10.1016/j.ejso.2020.02.027R. E. Clifford, H. Fowler, N. Govindarajah, D. Vimalachandran, P.A. Sutton. Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage. Surgical Endoscopy, vol. 33, no. 4. 2019, https://doi.org/10.1007/s00464-019-06670-9R. E. Clifford, H. Fowler, N. Govindarajah, D. Vimalachandran, P.A. Sutton. Early anastomotic complications in colorectal surgery: a systematic review of techniques for endoscopic salvage. Surgical Endoscopy, vol. 33, no. 4. 2019, https://doi.org/10.1007/s00464-019-06670-9Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol. 2018 Jun 7;24(21):2247-2260. doi:10.3748/wjg.v24.i21.2247Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol. 2018 Jun 7;24(21):2247-2260. doi:10.3748/wjg.v24.i21.2247Vasiliu EC, Zarnescu NO, Costea R, Neagu S. Review of Risk Factors for Anastomotic Leakage in Colorectal Surgery. Chirurgia (Bucur). 2015 Jul-Aug;110(4):319-26.Vasiliu EC, Zarnescu NO, Costea R, Neagu S. Review of Risk Factors for Anastomotic Leakage in Colorectal Surgery. Chirurgia (Bucur). 2015 Jul-Aug;110(4):319-26.Meyer J, Naiken S, Christou N, Liot E, Toso C, Buchs NC, Ris F. Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges. World J Gastroenterol. 2019 Sep 14;25(34):5017-5025. doi:10.3748/wjg.v25.i34.5017Meyer J, Naiken S, Christou N, Liot E, Toso C, Buchs NC, Ris F. Reducing anastomotic leak in colorectal surgery: The old dogmas and the new challenges. World J Gastroenterol. 2019 Sep 14;25(34):5017-5025. doi:10.3748/wjg.v25.i34.5017Галлямов Э.А., Агапов М.А., Луцевич О.Э., Кубышкин В.А., Какоткин В.В. Попытка оптимизации сроков реконструкции гастроинтестинального тракта на примере раннего закрытия илеостом у больных раком прямой кишки. рандомизированное мультицентровое исследование. Хирургическая практика. 2019;(3):24-31. https://doi.org/10.38181/issn2223-2427.2019.3.24-31Galliamov E.A., Agapov M.A., Lucevich O.E., Kubyshkin V.A., Kakotkin V.V. Trying to optimize the timing of reconstruction of gastrointestinal tract, on the example of early closure of the ileostomy in patients with rectal cancer. randomized multicenter study. Surgical practice. 2019;(3):24-31. (In Russ.) https://doi.org/10.38181/issn2223-2427.2019.3.24-31Allaix ME, Lena A, Degiuli M, Arezzo A, Passera R, Mistrangelo M, Morino M. Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections. Surg Endosc. 2019 May;33(5):1592-1599. https://doi.org/10.1007/s00464018-6421-8Allaix ME, Lena A, Degiuli M, Arezzo A, Passera R, Mistrangelo M, Morino M. Intraoperative air leak test reduces the rate of postoperative anastomotic leak: analysis of 777 laparoscopic left-sided colon resections. Surg Endosc. 2019 May;33(5):1592-1599. https://doi.org/10.1007/s00464018-6421-8Wu Z, van de Haar RC, Sparreboom CL, Boersema GS, Li Z, Ji J, Jeekel J, Lange JF. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis. 2016 Aug;31(8):1409-17. https://doi.org/10.1007/s00384-0162616-4Wu Z, van de Haar RC, Sparreboom CL, Boersema GS, Li Z, Ji J, Jeekel J, Lange JF. Is the intraoperative air leak test effective in the prevention of colorectal anastomotic leakage? A systematic review and meta-analysis. Int J Colorectal Dis. 2016 Aug;31(8):1409-17. https://doi.org/10.1007/s00384-0162616-4Y. Yang, Y. Shu, F. Su, L. Xia, B. Duan, and X. Wu. Prophylactic transanal decompression tube versus non-prophylactic transanal decompression tube for anastomotic leakage prevention in low anterior resection for rectal cancer: a metaanalysis. Surg. Endosc., vol. 31, no. 4, 2017, https://doi.org/10.1007/s00464-016-5193-2Y. Yang, Y. Shu, F. Su, L. Xia, B. Duan, and X. Wu. Prophylactic transanal decompression tube versus non-prophylactic transanal decompression tube for anastomotic leakage prevention in low anterior resection for rectal cancer: a metaanalysis. Surg. Endosc., vol. 31, no. 4, 2017, https://doi.org/10.1007/s00464-016-5193-2H. J. Kim, J. W. Huh, H. R. Kim, and Y. J. Kim. Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: Case-control study using propensity score matching method. Am. J. Surg., vol. 207, no. 6, 2014, https://doi.org/10.1016/j.amjsurg.2013.07.047H. J. Kim, J. W. Huh, H. R. Kim, and Y. J. Kim. Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: Case-control study using propensity score matching method. Am. J. Surg., vol. 207, no. 6, 2014, https://doi.org/10.1016/j.amjsurg.2013.07.047J. Lago Oliver. The systematic use of fibrin-based biological adhesive to prevent leakage due to healing defects in rectal anastomosis significantly reduces сosts. J. Surg., vol. 3, no. 2, 2015, https://doi.org/10.11648/j.js.20150302.12J. Lago Oliver. The systematic use of fibrin-based biological adhesive to prevent leakage due to healing defects in rectal anastomosis significantly reduces сosts. J. Surg., vol. 3, no. 2, 2015, https://doi.org/10.11648/j.js.20150302.12S. Panda, M. P. Connolly, M. G. Ramirez, and J. B. de Heredia. Costs analysis of fibrin sealant for prevention of anastomotic leakage in lower colorectal surgery. Risk Manag. Healthc. Policy, vol. 13, 2020. doi:10.2147/RMHP.S221008S. Panda, M. P. Connolly, M. G. Ramirez, and J. B. de Heredia. Costs analysis of fibrin sealant for prevention of anastomotic leakage in lower colorectal surgery. Risk Manag. Healthc. Policy, vol. 13, 2020. doi:10.2147/RMHP.S221008Vakalopoulos KA, Daams F, Wu Z, Timmermans L, Jeekel JJ, Kleinrensink GJ, van der Ham A, Lange JF. Tissue adhesives in gastrointestinal anastomosis: a systematic review. J Surg Res. 2013 Apr;180(2):290-300. https://doi.org/10.1016/j.jss.2012.12.043Vakalopoulos KA, Daams F, Wu Z, Timmermans L, Jeekel JJ, Kleinrensink GJ, van der Ham A, Lange JF. Tissue adhesives in gastrointestinal anastomosis: a systematic review. J Surg Res. 2013 Apr;180(2):290-300. https://doi.org/10.1016/j.jss.2012.12.043Plat VD, Bootsma BT, van der Wielen N, Straatman J, Schoonmade LJ, van der Peet DL, Daams F. The role of tissue adhesives in esophageal surgery, a systematic review of literature. Int J Surg. 2017 Apr;40:163-168. https://doi.org/10.1016/j.ijsu.2017.02.093Plat VD, Bootsma BT, van der Wielen N, Straatman J, Schoonmade LJ, van der Peet DL, Daams F. The role of tissue adhesives in esophageal surgery, a systematic review of literature. Int J Surg. 2017 Apr;40:163-168. https://doi.org/10.1016/j.ijsu.2017.02.093J. R. McGregor, D. H. Reinbach, S. W. Dahill, and P. J. O’Dwyer. Effect of fibrin sealant on perianastomotic tumor growth in an experimental model of colorectal cancer surgery. Dis. Colon Rectum, vol. 36, no. 9, 1993, https://doi.org/10.1007/BF02047379J. R. McGregor, D. H. Reinbach, S. W. Dahill, and P. J. O’Dwyer. Effect of fibrin sealant on perianastomotic tumor growth in an experimental model of colorectal cancer surgery. Dis. Colon Rectum, vol. 36, no. 9, 1993, https://doi.org/10.1007/BF02047379Schips L, Dalpiaz O, Cestari A, Lipsky K, Gidaro S, Zigeuner R, Petritsch P. Autologous fibrin glue using the Vivostat system for hemostasis in laparoscopic partial nephrectomy. Eur Urol. 2006 Oct;50(4):801-5. https://doi.org/10.1016/j.eururo.2006.03.010Schips L, Dalpiaz O, Cestari A, Lipsky K, Gidaro S, Zigeuner R, Petritsch P. Autologous fibrin glue using the Vivostat system for hemostasis in laparoscopic partial nephrectomy. Eur Urol. 2006 Oct;50(4):801-5. https://doi.org/10.1016/j.eururo.2006.03.010A. Garayev, Ö. Aytaç, and F. Atuğ. Effect of autologous fibrin glue (VivostatTM) on lymphatic drainage and lymphocele formation in extended pelvic lymph node dissection in robot assisted radical prostatectomy, Eur. Urol. Suppl., vol. 18, no. 1, 2019, https://doi.org/10.1016/s1569-9056(19)31318-1A. Garayev, Ö. Aytaç, and F. Atuğ. Effect of autologous fibrin glue (VivostatTM) on lymphatic drainage and lymphocele formation in extended pelvic lymph node dissection in robot assisted radical prostatectomy, Eur. Urol. Suppl., vol. 18, no. 1, 2019, https://doi.org/10.1016/s1569-9056(19)31318-1Graziano F, Certo F, Basile L, Maugeri R, Grasso G, Meccio F, Ganau M, Iacopino DG. Autologous fibrin sealant (Vivostat(®)) in the neurosurgical practice: Part I: Intracranial surgical procedure. Surg Neurol Int. 2015 May 12;6:77. https://doi.org/10.4103/2152-7806.156871Graziano F, Certo F, Basile L, Maugeri R, Grasso G, Meccio F, Ganau M, Iacopino DG. Autologous fibrin sealant (Vivostat(®)) in the neurosurgical practice: Part I: Intracranial surgical procedure. Surg Neurol Int. 2015 May 12;6:77. https://doi.org/10.4103/2152-7806.156871F. Graziano, R. Maugeri, L. Basile, F. Meccio, and D. G. Iacopino, Aulogous fibrin sealant (Vivostat®) in the neurosurgical practice: Part II: Vertebro-spinal procedures, Surg. Neurol. Int., vol. 7, 2016, https://doi.org/10.4103/21527806.174894F. Graziano, R. Maugeri, L. Basile, F. Meccio, and D. G. Iacopino, Aulogous fibrin sealant (Vivostat®) in the neurosurgical practice: Part II: Vertebro-spinal procedures, Surg. Neurol. Int., vol. 7, 2016, https://doi.org/10.4103/21527806.174894Bayer A, Höntsch G, Kaschwich M, Dell A, Siggelkow M, Berndt R, Rusch R, Harder J, Gläser R, Cremer J. Vivostat Platelet-Rich Fibrin® for Complicated or Chronic Wounds-A Pilot Study. Biomedicines. 2020 Aug 6;8(8):276. https://doi.org/10.3390/biomedicines8080276Bayer A, Höntsch G, Kaschwich M, Dell A, Siggelkow M, Berndt R, Rusch R, Harder J, Gläser R, Cremer J. Vivostat Platelet-Rich Fibrin® for Complicated or Chronic Wounds-A Pilot Study. Biomedicines. 2020 Aug 6;8(8):276. https://doi.org/10.3390/biomedicines8080276Bayer A, Tohidnezhad M, Lammel J, Lippross S, Behrendt P, Klüter T, Pufe T, Jahr H, Cremer J, Rademacher F, Gläser R, Harder J. Platelet-Released Growth Factors Induce Differentiation of Primary Keratinocytes. Mediators Inflamm. 2017;2017:5671615. https://doi.org/10.1155/2017/5671615Bayer A, Tohidnezhad M, Lammel J, Lippross S, Behrendt P, Klüter T, Pufe T, Jahr H, Cremer J, Rademacher F, Gläser R, Harder J. Platelet-Released Growth Factors Induce Differentiation of Primary Keratinocytes. Mediators Inflamm. 2017;2017:5671615. https://doi.org/10.1155/2017/5671615C. Cipriani. Levels and kinetic of the growth factor release and antibacterial activity in allogenic platelet gel for treatment of GVHD ulcers: A study from the Rome transplant network. Bone Marrow Transplant., vol. 50, no. SUPPL. 1, 2015.C. Cipriani. Levels and kinetic of the growth factor release and antibacterial activity in allogenic platelet gel for treatment of GVHD ulcers: A study from the Rome transplant network. Bone Marrow Transplant., vol. 50, no. SUPPL. 1, 2015.Bayer A, Wijaya B, Möbus L, Rademacher F, Rodewald M, Tohidnezhad M, Pufe T, Drücke D, Gläser R, Harder J. Platelet-Released Growth Factors and Platelet-Rich Fibrin Induce Expression of Factors Involved in Extracellular Matrix Organization in Human Keratinocytes. Int J Mol Sci. 2020 Jun 20;21(12):4404. https://doi.org/10.3390/ijms21124404Bayer A, Wijaya B, Möbus L, Rademacher F, Rodewald M, Tohidnezhad M, Pufe T, Drücke D, Gläser R, Harder J. Platelet-Released Growth Factors and Platelet-Rich Fibrin Induce Expression of Factors Involved in Extracellular Matrix Organization in Human Keratinocytes. Int J Mol Sci. 2020 Jun 20;21(12):4404. https://doi.org/10.3390/ijms21124404C. Cipriani, Vivostat® System: clinical efficacy and antimicrobial activity, Transfus. Apher. Sci., vol. 50, 2014, https://doi.org/10.1016/s1473-0502(14)50044-4C. Cipriani, Vivostat® System: clinical efficacy and antimicrobial activity, Transfus. Apher. Sci., vol. 50, 2014, https://doi.org/10.1016/s1473-0502(14)50044-4R. Lundquist, M. H. Dziegiel, and M. S. Ågren, Bioactivity and stability of endogenous fibrogenic factors in platelet-rich fibrin. Wound Repair Regen., vol. 16, no. 3, 2008, doi:10.1111/j.1524-475X.2007.00344.xR. Lundquist, M. H. Dziegiel, and M. S. Ågren, Bioactivity and stability of endogenous fibrogenic factors in platelet-rich fibrin. Wound Repair Regen., vol. 16, no. 3, 2008, doi:10.1111/j.1524-475X.2007.00344.xJ. L. Velada and D. A. Hollingsbee. Physical Characteristics of Vivostat® Patient-Derived Sealant. Eur. Surg. Res., vol. 33, no. 5–6, 2001, https://doi.org/10.1159/000049737J. L. Velada and D. A. Hollingsbee. Physical Characteristics of Vivostat® Patient-Derived Sealant. Eur. Surg. Res., vol. 33, no. 5–6, 2001, https://doi.org/10.1159/000049737M. Klein, “Postoperative non-steroidal anti-inflammatory drugs and colorectal anastomotic leakage: NSAIDs and anastomotic leakage,” Dan. Med. J., vol. 59, no. 3, 2012.M. Klein, “Postoperative non-steroidal anti-inflammatory drugs and colorectal anastomotic leakage: NSAIDs and anastomotic leakage,” Dan. Med. J., vol. 59, no. 3, 2012.V. D. Plat, B. T. Bootsma, N. van der Wielen, D. L. van der Peet, and F. Daams, “Autologous activated fibrin sealant for the esophageal anastomosis: a feasibility study,” J. Surg. Res., vol. 234, 2019, https://doi.org/10.1016/j.jss.2018.08.049V. D. Plat, B. T. Bootsma, N. van der Wielen, D. L. van der Peet, and F. Daams, “Autologous activated fibrin sealant for the esophageal anastomosis: a feasibility study,” J. Surg. Res., vol. 234, 2019, https://doi.org/10.1016/j.jss.2018.08.049L. G.C. and H. I., “Ducest-therapy, an innovative treatment for therapy of refractory chronic lower leg ulcers,” Transfusion Medicine and Hemotherapy, vol. 42. 2015.L. G.C. and H. I., “Ducest-therapy, an innovative treatment for therapy of refractory chronic lower leg ulcers,” Transfusion Medicine and Hemotherapy, vol. 42. 2015.K. Udo, W. Claudio, Q. Rodrigo, L. Francisco, J. Claudio, and Z. Alejandro, “P-115 Local Experience for Treatment of IBD-Related Recurrent Anal Fistulae Based on Autologous Stem-Cells and Platelet Rich Plasma,” Inflamm. Bowel Dis., vol. 20, 2014, https://doi.org/10.1097/01.mib.0000456844.47907.0aK. Udo, W. Claudio, Q. Rodrigo, L. Francisco, J. Claudio, and Z. Alejandro, “P-115 Local Experience for Treatment of IBD-Related Recurrent Anal Fistulae Based on Autologous Stem-Cells and Platelet Rich Plasma,” Inflamm. Bowel Dis., vol. 20, 2014, https://doi.org/10.1097/01.mib.0000456844.47907.0aR. Tutino, Autologous adipose-derived stem cells and platelets concentrates for the treatment of complex perianal fistulas, Tech. Coloproctol., vol. 24, 2020.R. Tutino, Autologous adipose-derived stem cells and platelets concentrates for the treatment of complex perianal fistulas, Tech. Coloproctol., vol. 24, 2020.A. Moreno-Serrano, J. J. García-Díaz, M. Ferrer-Márquez, R. Alarcón-Rodríguez, A. Álvarez-García, and Á. Reina-Duarte, Using autologous platelet-rich plasma for the treatment of complex fistulas, Rev. Esp. Enferm. Dig., vol. 108, no. 3, 2016, https://doi.org/10.17235/reed.2016.3946/2015A. Moreno-Serrano, J. J. García-Díaz, M. Ferrer-Márquez, R. Alarcón-Rodríguez, A. Álvarez-García, and Á. Reina-Duarte, Using autologous platelet-rich plasma for the treatment of complex fistulas, Rev. Esp. Enferm. Dig., vol. 108, no. 3, 2016, https://doi.org/10.17235/reed.2016.3946/2015

The authors declare that there are no conflicts of interest present.