Reinforcement of Colonic Anastomoses with a Collagenous Double-Layer Matrix Extracted from Porcine Dermis

Abstract

Background: Anastomotic leakage is a major factor for morbidity in colorectal surgery. Anastomotic reinforcement with biological or synthetic materials has been claimed to be useful in preventing anastomotic leakage. Methods: We evaluated a non-cross-linked collagenous matrix Bio-Gide® (BG) for sealing colonic anastomoses in a rodent model. The animals were investigated for 4, 30 and 90 days. Macroscopic examination, histological examination and measurement of bursting pressure were performed. The anastomotic stricture rate was evaluated by radiographic contrast enema. Results: Microscopically anastomoses sealed by BG showed impaired anastomotic healing. Blood vessel ingrowth and collagen deposition were decreased without reaching significance after 4 days. The anastomotic bursting pressure was significantly decreased (p = 0.0454) in the early phase of healing. Anastomotic neovascularization was significantly decreased compared to the control group after 30 (p = 0.0058) and 90 days (p = 0.0275). Although no difference in anastomotic stricture rate was evident, the rate of intra-abdominal adhesions was significantly increased after 30 (p = 0.0124) and 90 days (p = 0.0281). Conclusion: BG failed to improve colonic anastomotic healing. Early anastomotic healing was impaired if anastomoses were reinforced with BG. BG did not affect the anastomotic stricture rate for up to 3 months; nevertheless, intra-abdominal adhesions were increased.

The effect of chitosan coating on surgical sutures to strengthen the colonic anastomosis

“…Moreover, there are many different biological and artificial materials for the prevention of anastomotic leakage and the reinforcing of anastomosis by covering it, like Bio-Gide, grafts, meshes, [2] which have been investigated. In addition, the bio-sutures like the mesenchymal stem cell-coated suture, [19] albumin-coated bioactive suture, [20] IGF-1-coated sutures, [21] protein-coated sutures [22] were used in various types of wound-healing processes.…”

“…[1] Anastomotic leakage following colorectal resections occurs in 3%-23% of cases. [2] For various reasons, this anastomotic dehiscence is a major problem for anastomotic healing. To reduce this complication, reinforcement of the anastomosis by biological or artificial materials has been tried.…”

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

“…Reports regarding the use of synthetic materials are, however, uncommon and with discordant outcomes [27], [28]. Hand in hand with the use of the biologic mesh in abdominal wall repair, many experimental studies on their application as reinforcement of anastomosis have spread, and the bovine pericardium [13]–[16], small intestinal submucosa [17]–[19] and porcine dermis [20] are the biomaterials used. The biological materials are all basically composed of an extracellular matrix deprived of its cellular components.…”

A light-activated amnion wrap strengthens colonic anastomosis and reduces peri-anastomotic adhesions

“…Cyanoacrylate glues have also been tried, but with little success . A number of tissues and materials have been used to externally bolster the anastomosis including omentum , bovine pericardium , adhesive barrier materials , collagen‐based scaffolds , and amniotic membrane . These require fixation of the material over the anastomosis site, typically with suture.…”