Adipose derived mesenchymal stem cells in gastrointestinal system anastomosis: a narrative review

Background and Objective: Gastrointestinal (GI) system anastomosis is an artificial connection procedure after a resection of all or part of the digestive organs. GI system anastomosis may lead to many complications, including anastomotic leakage (AL), anastomotic dehiscence, or stenosis. AL from anastomosis is one of the most important and fatal complication of any GI resection. Prevention of AL has been a hot topic of ongoing research for decades. Methods: To elucidate recent advances on therapeutic efficacy of adipose-derived mesenchymal stem cells (ADMSCs) in anastomosis, we performed a review of the published literature in English from September 2008 to February 2022 by independent searches using publicly available databases, including NIH National Library of Medicine PubMed, Web of Science, MEDLINE and conferences on this topic. Key Content and Findings: Physical reinforcement of the anastomosis with supporting materials is considered as an effective method to prevent leakage. Liquid-based sealants have also been explored as one of the preventive methods. Finally, manipulating the interaction between the gut microbiome microenvironment and anastomotic healing has also been studied as a means to reduce leakage rates. However, although various surgical techniques have been developed to reduce AL, it remains to be one of the most serious and fatal postoperative complications. Recently, ADMSCs have been popularly used for accelerating anastomotic wound healing through their angiogenesis, immunomodulatory effects and tissue repair ability. Conclusions: An understanding of above developing advances will be important for all surgeons who operate on the GI systems. Here, our review discusses recent advances in the application of various updated techniques, especially ADMSCs transplantation in GI system anastomosis that may stimulate future human studies exploring these new and exciting avenues. collagen-3 α 1 were evaluated. Results showed that MSC sheets enhanced intestine bursting pressure (P<0.05) and up-regulated the mRNA expression of collagen-1 and collagen-3. Hydroxyproline expression was significantly higher in MSC sheet subgroup on PO d 7 (P<0.01) but not PO d 5.