Collagen fleeces do not improve colonic anastomotic strength but increase bowel obstructions in an experimental rat model

Abstract

PurposeTo investigate whether a collagen fleece kept in place by fibrin glue might seal off a colorectal anastomosis, provide reinforcement, and subsequently improve anastomotic healing.MethodsWistar rats underwent a 1-cm left-sided colonic resection followed by a 4-suture end-to-end anastomosis. They were then randomly assigned to one of three treatment groups: no additional intervention (control, n = 20), the anastomosis covered with fibrin glue (fibrin glue, n = 20), the anastomosis covered with a collagen fleece, kept in place with fibrin glue (collagen fleece, n = 21). At either 3 or 7 days follow-up, anastomotic bursting pressure was measured and tissue was obtained for histology and collagen content assessment after which animals were sacrificed.ResultsThree rats in the control (15%), three in the fibrin glue (15%), and one in the collagen group (4.8%) died due to anastomotic complications (P = 0.497). Anastomotic bursting pressures were not significantly different between groups at 3 and 7 days follow-up (P = 0.659 and P = 0.427, respectively). However, bowel obstructions occurred significantly more often in the collagen group compared to the control group (14/21 vs. 3/20, P = 0.003). Collagen contents were not different between groups, but histology showed a more severe inflammation in the collagen group compared to the other groups at both 3 and 7 days follow-up.ConclusionsA collagen fleece kept in place by fibrin glue does not improve healing of colonic anastomoses in rats. Moreover, this technique induces significantly more bowel obstructions in rats, warranting further study before being translated to a clinical setting.

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

“…In another study by the same authors, antibiotics were added to the FG sealant, causing reduced inflammation and increased bursting pressure and collagen content [68]. In line with this, another study suggested that impaired healing after sealing was due to the intraluminal confinement of bacteria together with a reduced peritoneal contact of the anastomoses [72]. These findings suggest that impaired healing may be due to inflammation and/or foreign body reaction caused by the sealing, by bacteria from the colon or both.…”

“…In 7 of the 28 studies, a positive effect of FG on healing was found [55,56,57,58,59,60,61], while 8 studies reported a negative effect [62,63,64,65,66,67,68,69] and 11 studies found no effect [54,70,71,72,73,74,75,76,77,78,79]. Furthermore, 2 studies reported unclear results [80,81] (table 2).…”

Comparison of three different application routes of butyrate to improve colonic anastomotic strength in rats

“…Unfortunately, the attachment of a patch into the colon caused extension of the bowel proximal to the location of the patch, indicating colonic stenosis. This effect of patches or fleeces has been previously described [ 26 ]; however, in that study, the authors used an external fleece and in experiment 1, the film-like resorbable patches were attached intraluminally. This stenosis effect—clinically translatable to ileus—could be the explanation of why the animals in experiment 1 had lower welfare scores and lower weight compared to the other groups.…”

The application of TachoSil® for sealing colorectal anastomosis: a feasibility study

“…[18] also reported improved anastomotic integrity when TachoComb (the predecessor product to TachoSil) was used as suture support in colonic anastomoses in a rat model, an increased inflammatory response was observed. Greater inflammation, as well as more frequent bowel obstruction, was also observed when a collagen fleece (Tissufleece) was used in addition to fibrin glue in a recent study in rats [19]. However, as the authors highlight, translation of these experimental data to the clinical situation may be limited, for example because of differences in the relative dimensions of the colon and collagen fleece, and the increased manipulation needed for fleece application in a small rodent model being associated with greater trauma risk.…”