Real-World Outcomes Following Dehydrated Human Amnion/Chorion Membrane Use in Left-Sided Colectomy Without a Protective Stoma: A Multicenter Pilot Study

Abstract

Background: Anastomotic leak is a critical complication following colorectal surgery, contributing to reintervention, readmission, prolonged hospitalization, and substantial downstream healthcare costs. Despite advances in surgical technique and perioperative care, leak rates following left-sided colectomy have not meaningfully declined. Dehydrated human amnion/chorion membrane (DHACM) is a placental allograft that contains and releases a broad array of biological mediators implicated in angiogenesis, fibroblast recruitment, and extracellular matrix remodeling. While these properties suggest a potential role in anastomotic healing, clinical data in colorectal surgery remain limited. Methods: This retrospective, multicenter, observational cohort study evaluated consecutive adult patients who received DHACM during left-sided colectomy with primary colorectal anastomosis and circumferential application of DHACM between January 2016 and June 2024. Patients receiving a protective stoma were excluded. The primary outcome was the incidence of anastomotic leak within 30 days according to the International Study Group of Rectal Cancer (ISGRC) criteria. Secondary outcomes included 30-day readmission, reoperation, length of stay, emergency department visits, and mortality. Outcomes were summarized descriptively. Results: A total of 287 patients met inclusion criteria, including a heterogeneous population undergoing surgery for both benign and malignant indications. Five patients (1.7%) experienced an anastomotic leak: four Grade B events managed nonoperatively and one event requiring reoperation, with an intact anastomosis noted intraoperatively and classified as Grade C based on reoperation. The 30-day all-cause readmission rate was 3.1%, median postoperative length of stay was 2 days (IQR 1.25–3), and no deaths occurred. No graft-related adverse events were reported. Exploratory subgroup analyses did not identify meaningful differences in leak rates across operative or clinical characteristics. Conclusions: In this real-world multicenter pilot study of DHACM applied around the colorectal anastomosis in patients undergoing left-sided colectomy without a protective stoma, low rates of anastomotic leak and 30-day all-cause readmission were observed. Although limited by its retrospective, single-arm design and lack of an internal comparator, these hypothesis-generating findings support the feasibility and tolerability of DHACM as a surgical adjunct at the colorectal anastomosis and provide a rationale for prospective, controlled evaluation in colorectal surgery.