Anastomotic Sealing by Extracellular Matrices (ECM) Improves Healing of Colonic Anastomoses in the Critical Early Phase

Hoeppner, Jens; Wassmuth, Bettina; Marjanović, Goran; Timme, Sylvia; Hopt, Ulrich T.; Keck, Tobias

doi:10.1007/s11605-010-1191-1

Cited by 28 publications

(16 citation statements)

References 36 publications

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“…Some Authors described that the reinforcement with collagen fleeces could cause intestinal obstruction, resulting from the phenomena of shrinkage and displacement of the prosthesis [12], [17]. Moreover, we found decreased rate of intra-abdominal adhesions compared to standard anastomoses, while other studies showed a similar entity of adhesions [17], [18]. As expected, when the iatrogenic perforation had been performed without any reinforcement, a diffuse and severe peritonitis was the intraoperative finding.…”

Section: Discussionsupporting

confidence: 79%

Bovine Pericardium Patch Wrapping Intestinal Anastomosis Improves Healing Process and Prevents Leakage in a Pig Model

et al. 2014

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Failure of intestinal anastomosis is a major complication following abdominal surgery. Biological materials have been introduced as reinforcement of abdominal wall hernia in contaminated setting. An innovative application of biological patch is its use as reinforcement of gastrointestinal anastomosis. The aim of study was to verify whether the bovine pericardium patch improves the healing of anastomosis, when in vivo wrapping the suture line of pig intestinal anastomosis, avoiding leakage in the event of deliberately incomplete suture. Forty-three pigs were randomly divided: Group 1 (control, n = 14): hand-sewn ileo-ileal and colo-colic anastomosis; Group 2 (n = 14): standard anastomosis wrapped by pericardium bovine patch; Group 3 (n = 1) and 4 (n = 14): one suture was deliberately incomplete and also wrapped by patch in the last one. Intraoperative evaluation, histological, biochemical, tensiometric and electrophysiological studies of intestinal specimens were performed at 48 h, 7 and 90 days after. In groups 2 and 4, no leak, stenosis, abscess, peritonitis, mesh displacement or shrinkage were found and adhesion rate decreased compared to control. Biochemical studies showed mitochondrial function improvement in colic wrapped anastomosis. Tensiometric evaluations suggested that the patch preserves the colic contractility similar to the controls. Electrophysiological results demonstrated that the patch also improves the mucosal function restoring almost normal transport properties. Use of pericardium bovine patch as reinforcement of intestinal anastomosis is safe and effective, significantly improving the healing process. Data of prevention of acute peritonitis and leakage in cases of iatrogenic perforation of anastomoses, covered with patch, is unpublished.

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Section: Discussionsupporting

confidence: 79%

Bovine Pericardium Patch Wrapping Intestinal Anastomosis Improves Healing Process and Prevents Leakage in a Pig Model

et al. 2014

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“…The occurrence of dehiscence is particularly high when suture is performed in the distal colon due to associated fecal loading and technical difficulty 13 . High mortality and severe morbidity associated with dehiscence support the need for further evaluation of methods aiming to reduce its incidence 14 and the deleterious effects of drugs on wound healing.…”

Section: Discussionmentioning

confidence: 99%

Effects of bromopride on the healing of left colonic anastomoses in rats with induced abdominal sepsis

Silva¹,

Carneiro

Oliveira

et al. 2012

Acta Cir. Bras.

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PuRPOSE:To evaluate the effects of bromopride on the healing of left colonic anastomoses in rats with induced abdominal sepsis. METHOdS: Forty rats were divided into two groups to receive either bromopride (experimental group-E) or saline (control group-C). Each group was divided into subgroups of ten animals each to be euthanized on third (E3 and C3) or seventh day (E7 and C7) after surgery. Sepsis was induced by cecal ligation and puncture. The rats underwent segmental left colon resection and end-to-end anastomosis. Adhesion formation, tensile strength and hydroxyproline concentration were assessed. Histomorphometry of collagen and histopathological analysis were also performed. RESuLTS: On postoperative third day, anastomoses in bromopride-treated animals showed lower tensile strength (p=0.02) and greater reduction in hydroxyproline concentration (p=0.04) than in control animals. There was no statistical difference in these parameters on seventh day, and the remaining parameters were similar across subgroups. Collagen content was also similar across subgroups. CONCLuSION: In the presence of abdominal sepsis, the administration of bromopride was associated with decreased tensile strength and hydroxyproline concentration in left colonic anastomoses in rats three days after surgery. Key words: Anastomosis, Surgical. Colon. Sepsis. Grastrointestinal Motility. Tissue Adhesions. Rats. RESuMO OBJETIVO:Avaliar os efeitos da bromoprida sobre a cicatrização de anastomoses de cólon esquerdo de ratos na presença de sepse abdominal. MéTOdOS: Quarenta ratos distribuídos em grupos contendo 20 animais para administração de bromoprida ou salina. Cada grupo foi dividido em subgrupos contendo dez animais, para eutanásia no terceiro ou no sétimo dia de pós-operatório. A indução da sepse foi realizada pelo método de ligadura e punção do ceco. Foi realizada ressecção de um segmento do cólon esquerdo e anastomose término-terminal. À re-laparotomia, foi avaliada a quantidade total de aderências e removido um segmento colônico contendo a anastomose para análise histopatológica, força de ruptura, concentração de hidroxiprolina e histomorfometria do colágeno. RESuLTAdOS: No 3° DPO, as anastomoses dos animais tratados com bromoprida apresentaram menor força de ruptura (p=0,02) e maior redução da concentração de hidroxiprolina (p=0,04) que os animais controle. Não houve diferença estatística quanto a estes parâmetros no 7° DPO. O conteúdo de colágeno foi semelhante entre os subgrupos. CONCLuSãO: Na presença de sepse abdominal, o uso da bromoprida esteve associado à diminuição da força de ruptura e da concentração de hidroxiprolina das anastomoses do cólon esquerdo de ratos no 3° DPO. descritores: Anastomose Cirúrgica. Cólon. Sepse. Motilidade Gastrointestinal. Aderências Teciduais. Ratos. Effects of bromopride on the healing of left colonic anastomoses in rats with induced abdominal sepsis

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“…It was chosen not to include collagen staining in the 12-suture control group due to ethical reasons, as these findings are well-known and have been reported in numerous recent studies [9–11]. Collagen percentage of anastomotic tissue was calculated.…”

Section: Methodsmentioning

confidence: 99%

Impact of tissue adhesives on the prevention of anastomotic leakage of colonic anastomoses: an in vivo study

Vakalopoulos

Bosmans

Barneveld

et al. 2017

Int J Colorectal Dis

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BackgroundTissue adhesives (TA) may be useful to strengthen colorectal anastomoses, thereby preventing anastomotic leakage (AL). Previous studies have identified cyanoacrylate (CA) TAs as the most promising colonic anastomotic sealants. This study investigates the protective effects of sealing colonic anastomoses with various CAs.Materials and methodsFifty-five Wistar rats underwent laparotomy and transection of the proximal colon. An anastomosis was created with 4 interrupted sutures followed by either application of Histoacryl Flexible, Omnex, Glubran 2, or no TA seal. An additional control group was included with a 12-suture anastomosis and no TA seal. After 7 days, the rats were sacrificed and scored for the presence of AL as the main outcome. Secondary outcomes were the occurrence of bowel obstruction, adhesions, and anastomotic bursting pressure. Histological evaluation was performed.ResultsThe highest AL rate was found in the Glubran 2 group (7/11), followed by the 4-sutures group without TA (5/11), and the Omnex group (5/11). Histoacryl Flexible showed the lowest AL rate (2/11). In the control group, only one rat showed signs of AL. Histologically, the highest influx of inflammatory cells was found in the 4-suture group without TA and for Omnex and Glubran 2. Histoacryl Flexible caused more mature collagen deposition when compared to the other TA groups.ConclusionsHistoacryl Flexible showed the lowest leakage rate compared to the other TA groups and to the 4-suture control group. Glubran 2 showed the highest AL rate and a high inflammatory response. Histoacryl Flexible was associated with the presence of more mature collagen and seems to promote anastomotic healing.

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Anastomotic Sealing by Extracellular Matrices (ECM) Improves Healing of Colonic Anastomoses in the Critical Early Phase

Abstract: Especially in the critical phase of anastomotic healing up to day 4, anastomotic healing was improved by SIS sealing. SIS sealing did not cause long-term complications.

Cited by 28 publications

References 36 publications

Bovine Pericardium Patch Wrapping Intestinal Anastomosis Improves Healing Process and Prevents Leakage in a Pig Model

Bovine Pericardium Patch Wrapping Intestinal Anastomosis Improves Healing Process and Prevents Leakage in a Pig Model

Effects of bromopride on the healing of left colonic anastomoses in rats with induced abdominal sepsis

Impact of tissue adhesives on the prevention of anastomotic leakage of colonic anastomoses: an in vivo study

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