Use of Human Amnion/Chorion Membrane as a Protective Barrier in Complicated Diverticulitis Patients Undergoing Colorectal Resections.

Abstract

Introduction: Anastomotic leaks are a serious complication of colorectal surgery, particularly in patients undergoing colectomy for complicated diverticulitis. Dehydrated human amnion/chorion membrane (DHACM) allografts are FDA-regulated, non-viable cellular allografts derived from donated human placentas. This tissue is rich in cytokines and growth factors critical in wound healing and tissue growth. Animal models have demonstrated the benefits of these grafts for anastomotic healing in terms of increased bursting pressures, neoangiogenesis, fibroblast activity, collagenization, and epithelialization, as well as decreased inflammation. This study evaluated real-world outcomes associated with DHACM use as a protective barrier wrapped around the anastomotic site in patients undergoing colorectal resection for complicated diverticulitis.

Methods: This retrospective, multi-center study analyzed consecutive adult patients undergoing left-sided colectomy with primary colorectal anastomosis and DHACM application, between January 2016 and June 2024. Patients with uncomplicated diverticulitis or receiving protective stoma were excluded. The primary outcome was anastomotic leak incidence within 30 days of surgery. Secondary outcomes included reoperation, readmission, length of stay, and mortality. Outcomes were summarized descriptively.

Results: The study included 178 complicated diverticulitis patients with left-sided colectomy and no protective stoma. Three patients (1.7%) experienced an anastomotic leak, including two grade B leaks managed with antibiotics and one grade C leak requiring reoperation. The 30-day all-cause readmission rate was 3.9% (7/178), the median length of stay was 2 days and only 3 patients (1.7%) returned to surgery.

Conclusions: In this real-world cohort of complicated diverticulitis patients undergoing colectomy, low rates of anastomotic leak, readmission, and reoperation were observed following application of DHACM around the anastomosis. These findings suggest DHACM may be a promising adjunct to support anastomotic healing in this high-risk population. Controlled prospective studies are warranted to confirm these observations.