Safety and Efficacy of the Use of Bioabsorbable Seamguard in Colorectal Surgery at the Texas Endosurgery Institute

Abstract

Bioabsorbable Seamguard (BSG) is a random-fiber web of polyglycolic acid/trimethylene carbonate. It is completely absorbed within 6 months or less due to its constitution of a bioabsorbable membrane with polyester braided suture. It has been used in obesity surgery and pulmonary surgery as staple-line reinforcement with good results. As such, we believe that BSG may be ideal to use in colorectal surgery as an aid during the healing process of an anastomosis and may help prevent anastomotic bleeding and staple-line disruption. From July 2003 through September 2004, 30 patients underwent placement of BSG for the following procedures: 12 right hemicolectomies, 7 low anterior resections, 5 sigmoid colectomies, 3 total colectomies, 2 partial resections, and 1 colostomy closure. Median follow-up was 7 months (range 1-13). There were no clinical leaks, no strictures, and no bleeding in our early postoperative follow-up period. The use of BSG as a staple-line reinforcer appears to be safe and may be useful in preventing anastomotic leakage, bleeding, and intraluminal stenosis.

A comparison of gastrojejunal anastomoses with or without buttressing in a porcine model

“…Since experimental models have shown declines in anastomotic strength of small bowel [46] and colon [47,48] during the early postoperative course, our finding may have important clinical applications. This finding possibly explains the low anastomotic leak rates that have been reported using this material [16,19,49]. At 1 week, burst pressures were significantly lower with the addition of BSG to the circular-stapled anastomoses.…”

“…The clinical implications of our findings require further long-term studies to evaluate the impact decreased collagen content and chronic burst pressures have on intestinal burst strength and stricture formation. Although clinical data are sparse and include small series, the decreased burst pressures we observed and decreased collagen content do not appear to clinically affect the strength of the anastomosis [16][17][18]49].…”

“…Several staple-line buttresses have been used to minimize these complications, with favorable results [12][13][14][15][16][17][18][19].…”

Buttressing of the Staple Line in Gastrointestinal Anastomoses: Overview of New Technology Designed to Reduce Perioperative Complications

“…The effects in colorectal anastomosis have been investigated in a pilot study of 30 patients in which all anastomoses were performed with a linear stapler [51]. Although mainly safety and ease of use were demonstrated in this study, no bleeding and clinically apparent leakage could be seen at the staple line.…”

Evaluation of Unmeshed and 1:1 Meshed AlloDerm Bolsters for Stapled Rectal Anastomoses in a Porcine Model

“…The average clinical leak rate for stapled colorectal anastomoses is approximately 4-5% and can increase to 15-20% for low colorectal and coloanal anastomoses. [1][2][3] The range of clinical leak rates after low anterior resection of the rectum is 3-39%, [4][5][6][7][8] and radiographic leak rates have an even higher incidence, depending on their timing after surgery. 9 Patients are usually quite ill after an anastomotic leak, and the estimated mortality from this complication can be greater than 20%.…”