Background: Postoperative pancreatic fistula is a complication that occurs after hepatobiliary surgery or gastric cancer surgery. Although this complication could be fatal, its treatment is mainly conservative with drainage.
Amniotic membrane cells are known to secrete βdefensin, elafin, and secretory leukocyte peptidase inhibitor (SLPI) and to secrete anti-inflammatory cytokines, wound healing factors. Due to these characteristics, several applications of amniotic membranes for skin ulcer and burn treatment have been reported, and they are already in clinical use in ophthalmology. In this study, we focused on the antibacterial, anti-inflammatory, and wound-healing effects of amniotic membranes and aimed to develop a treatment method for pancreatic leakage using amniotic membranes.
Methods: The amniotic membrane was aseptically removed from the placenta of a pregnant woman who delivered by Cesarean section at Tohoku University Hospital and used for the experiment.
Referring to the pancreatic fistula model reported in the past, a pancreatic leakage model is created by amputating the splenic duct with the pancreatic parenchyma. The pancreatic stump was covered with amniotic membrane, and the levels of amylase and lipase in ascites were measured on days 1, 3, and 5 to verify the inhibitory effect of amniotic membrane on pancreatic leakage.
Results: The pancreas was dissected at the level of the left margin of the superior mesenteric vein and the splenic duct, and the pancreatic tail and spleen were resected. Results for the control group and amnion-covered group, in order of day1,3,5, were (1864 ± 567, 243 ± 29, 296 ± 149) and (995 ± 297, 629 ± 450, 97 ± 14) for ascites amylase, (348 ± 141, 46 ± 5 ,81 ± 32 ) and (126 ± 46, 129 ± 94,35 ± 1) for ascites lipase. No statistically significant differences were observed.
Conclusion: The experimental model used in this study, in which the pancreatic body is amputated, did not reveal any effect of the use of an amniotic membrane on lowering pancreatic enzymes in ascites. This may be partly due to the large variation in amylase and lipase values in the ascites fluid. The effects of the amniotic membrane are under investigation and verified by histological evaluation in the future.