Intestinal anastomotic healing in the absence of suture material: an experimental study in rats

A new biodegradable adhesive for protection of intestinal anastomoses. Preliminary communication

BACKGROUND AND AIMS

Anastomotic leaks continue to be a devastating complication for patients and surgeons worldwide. The few surgical adhesives available to date have not achieved the desired clinical results. The purpose of this experimental study was to determine if Pebisut® applied to intestinal suture lines provides increased resistance and protection during the critical days of healing.

METHODS

Intestinal lesions were caused in rats and dogs and a new biodegradable adhesive (Pebisut®) (patent granted in the European Union 07808494.4-1219, 01.12.2010, in Mexico P.C.T./MX/a/2009/001737, 16.02.2009, pending in the U.S.P.T.O. 60/762,136, 26.01.2006) was applied to compare the resistance of suture lines using bursting pressures and histologically.

RESULTS

Under acute and chronic conditions, Pebisut® strengthened and made the suture lines more resistant, while histologically penetrating and sealing them. The adhesive disappears within 2-3 weeks and is well tolerated by the intestinal tissues.

CONCLUSIONS

This biodegradable adhesive provides greater resistance, temporarily protects suture lines and may prevent anastomotic leaks.

Anastomotic healing in ileum and colon of alloxan-induced diabetic rats

PURPOSE: To investigate if diabetes mellitus may alter breaking strength (BS) and collagen content in ileum and colon anastomoses in rats. METHODS: Three-hundred Wistar rats were randomly assigned to 5 experimental groups, 60 per group: normal controls surgically manipulated (G1); normal controls submitted to ileum (G2) and colon (G3) anastomotic construction; diabetic rats submitted to ileum (G4) and colon (G5) anastomotic construction. Each group was further divided into 6 subgroups with 10 rats each for sacrifice at 0, 4, 7, 14, 21, and 30 days after surgery. All surgical procedures were performed 3 months after alloxan diabetes induction. BS was measured in all intestinal anastomoses. Fragments of ileum and colon anastomoses were taken for hydroxyproline concentration (HP) and total tissue protein (TP) dosages. RESULTS: Anastomotic BS was significantly decreased (P<0.05) in ileum and colon of G4 and G5 diabetic groups up to 7 and 14 days after surgery, respectively, compared with G2 and G3 normal control groups. Anastomotic HP and TP content did not significantly differ between diabetic and normal control operated groups in ileum or colon at all evaluation times. CONCLUSION: Experimental diabetes leads to impaired intestinal anastomotic strength during early surgical wound repair, but does not appear to be implicated with collagen synthesis capacity.

Cellular proliferation at sutured and sutureless colonic anastomoses

Elevated cellular proliferation in the vicinity of an anastomosis may explain the enhanced susceptibility to carcinogens. The aim of this study was to determine whether anastomotic cellular proliferation was altered by different suture materials and whether a rise in cell turnover also occurred after a "sutureless" closure. A transverse descending colon enterotomy was repaired with interrupted sutures of 5/0 silk (n = 20), stainless steel (n = 20), or Vicryl (Ethicon, Inc., Somerville, NJ) (n = 20) or by a sutureless technique (n = 20). Using a stathmokinetic technique, crypt cell production rates (CCPR) were calculated at the anastomosis and in the adjacent colon at varying intervals between one week and six months after treatment. Overall colonic cellular proliferation appeared to be elevated at a sutured colotomy for at least three months (P < 0.05). In contrast, no significant elevation in cellular proliferation was observed at sutureless anastomoses. The duration of elevated proliferative response varied among the sutures.