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Gené-Škrabec C, Cremades M, Fernández-Pujol A, Cortinovis S, Corral J, Julián JF, Parés D. Clinical results after external reinforcement of colorectal anastomosis: a systematic review. Int J Surg 2023; 109:4322-4332. [PMID: 37707516 PMCID: PMC10720808 DOI: 10.1097/js9.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of this review is to describe and assess the existing methods to cover colorectal anastomoses with biomaterials and their clinical impact in reducing anastomotic leakage (AL). SUMMARY BACKGROUND DATA The most serious complication in colorectal surgery is AL. Despite improvements in its diagnosis and management, AL remains an unresolved issue. To prevent its appearance and clinical consequences, different external reinforcement techniques with synthetic or biomaterials have been described. METHODS A systematic review search of the available literature until June 2022 was performed, looking for all literature regarding external reinforcement of colonic or colorectal anastomoses. After the review process, a classification of materials was proposed into solid and liquid materials, and an assessment of their clinical impact was performed. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA and AMSTAR Guidelines 11,12 . RESULTS Ninety-seven articles that fulfilled inclusion criteria, were identified and revised. Overall, 18 of the selected articles focused on human clinical trials and 79 on animal models. Only fibrin sealants, collagen patches, and omentoplasty have shown positive results in humans. CONCLUSIONS Fibrin sealants, collagen patches, and omentoplasty are, so far, the most studied biomaterials. However, further studies are required to confirm these findings before definite recommendations can be made.
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Affiliation(s)
- Clara Gené-Škrabec
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - Manel Cremades
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | | | - Sara Cortinovis
- Department of General Surgery, ASUGI Cattinara, Università degli studi di Trieste, Trieste, Italy
| | - Javier Corral
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - Joan-F Julián
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - David Parés
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
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2
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Klicova M, Mullerova S, Rosendorf J, Klapstova A, Jirkovec R, Erben J, Petrzilkova M, Raabová H, Šatínský D, Melicherikova J, Palek R, Liska V, Horakova J. Large-Scale Development of Antibacterial Scaffolds: Gentamicin Sulfate-Loaded Biodegradable Nanofibers for Gastrointestinal Applications. ACS OMEGA 2023; 8:40823-40835. [PMID: 37929155 PMCID: PMC10620781 DOI: 10.1021/acsomega.3c05924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/29/2023] [Indexed: 11/07/2023]
Abstract
The ever-increasing demands of modern medicine drive the development of novel drug delivery materials. In particular, nanofibers are promising for such materials due to their favorable properties. However, most development is still carried out through laboratory techniques that do not allow extensive and reproducible characterization of materials, which slows medical research. In this work, we focus on the large-scale fabrication and testing of specific antibacterial nanofibrous materials to prevent the postoperative complications associated with the occurrence of bacterial infection. Poly-ε-caprolactone with gentamicin sulfate (antibiotic) in different concentrations was electrospun via a needleless device. The amount of antibiotics was proven by elemental analysis, UV spectrophotometry, and HPLC. The cytocompatibility of the materials was verified in vitro according to ISO 10993-5. The cell adhesion and proliferation were assessed after 2, 7, 14, and 21 days using the CCK-8 metabolic assay, fluorescence, and scanning electron microscopy. The tested nanofiber materials supported cell growth. Antibacterial tests were performed to confirm the release of gentamicin sulfate, and its antibacterial properties were proven toward Staphylococcus gallinarum and Escherichia coli bacteria. The effect of ethylene oxide sterilization was also studied. The sterilized nanofibrous layers are cytocompatible while antibacterial and therefore suitable for medical applications.
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Affiliation(s)
- Marketa Klicova
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, Liberec 461 17, Czech Republic
| | - Senta Mullerova
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, Liberec 461 17, Czech Republic
| | - Jachym Rosendorf
- Biomedical
Center, Faculty of Medicine in Pilsen, Charles
University, Alej Svobody 1655/76, Plzen 323 00, Czech Republic
| | - Andrea Klapstova
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, Liberec 461 17, Czech Republic
| | - Radek Jirkovec
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, Liberec 461 17, Czech Republic
| | - Jakub Erben
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, Liberec 461 17, Czech Republic
| | - Michaela Petrzilkova
- Faculty
of Mechatronics, Informatics and Interdisciplinary Studies, Institute of New Technologies and Applied Informatics, Studentska 1402/2, Liberec 461 17, Czech Republic
| | - Hedvika Raabová
- Faculty
of Pharmacy, The Department of Analytical Chemistry, Charles University, Akademika Heyrovskeho 1203, Hradec Kralove 500 05, Czech Republic
| | - Dalibor Šatínský
- Faculty
of Pharmacy, The Department of Analytical Chemistry, Charles University, Akademika Heyrovskeho 1203, Hradec Kralove 500 05, Czech Republic
| | - Jana Melicherikova
- The
Institute for Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Bendlova 7, Liberec 460 01, Czech Republic
| | - Richard Palek
- Biomedical
Center, Faculty of Medicine in Pilsen, Charles
University, Alej Svobody 1655/76, Plzen 323 00, Czech Republic
| | - Vaclav Liska
- Biomedical
Center, Faculty of Medicine in Pilsen, Charles
University, Alej Svobody 1655/76, Plzen 323 00, Czech Republic
| | - Jana Horakova
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, Liberec 461 17, Czech Republic
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3
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Suter B, Anthis AHC, Zehnder A, Mergen V, Rosendorf J, Gerken LRH, Schlegel AA, Korcakova E, Liska V, Herrmann IK. Surgical Sealant with Integrated Shape-Morphing Dual Modality Ultrasound and Computed Tomography Sensors for Gastric Leak Detection. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023; 10:e2301207. [PMID: 37276437 PMCID: PMC10427398 DOI: 10.1002/advs.202301207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Postoperative anastomotic leaks are the most feared complications after gastric surgery. For diagnostics clinicians mostly rely on clinical symptoms such as fever and tachycardia, often developing as a result of an already fully developed, i.e., symptomatic, surgical leak. A gastric fluid responsive, dual modality, electronic-free, leak sensor system integrable into surgical adhesive suture support materials is introduced. Leak sensors contain high atomic number carbonates embedded in a polyacrylamide matrix, that upon exposure to gastric fluid convert into gaseous carbon dioxide (CO2 ). CO2 bubbles remain entrapped in the hydrogel matrix, leading to a distinctly increased echogenic contrast detectable by a low-cost and portable ultrasound transducer, while the dissolution of the carbonate species and the resulting diffusion of the cation produces a markedly reduced contrast in computed tomography imaging. The sensing elements can be patterned into a variety of characteristic shapes and can be combined with nonreactive tantalum oxide reference elements, allowing the design of shape-morphing sensing elements visible to the naked eye as well as artificial intelligence-assisted automated detection. In summary, shape-morphing dual modality sensors for the early and robust detection of postoperative complications at deep tissue sites, opening new routes for postoperative patient surveillance using existing hospital infrastructure is reported.
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Affiliation(s)
- Benjamin Suter
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Alexandre H. C. Anthis
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Anna‐Katharina Zehnder
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
| | - Victor Mergen
- Diagnostic and Interventional RadiologyUniversity Hospital ZurichUniversity of ZurichRämistrasse 100Zürich8091Switzerland
| | - Jachym Rosendorf
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Lukas R. H. Gerken
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
| | - Andrea A. Schlegel
- Department of Surgery and TransplantationSwiss HPB CentreUniversity Hospital ZurichRämistrasse 100Zurich8091Switzerland
- Fondazione IRCCS Ca' GrandaOspedale Maggiore PoliclinicoCentre of Preclinical ResearchMilan20122Italy
- Transplantation Center, Digestive Disease and Surgery Institute and Department of Immunity and Inflammation, Lerner Research InstituteCleveland Clinic9620 Carnegie AveClevelandOH44106United States
| | - Eva Korcakova
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
- Department of Imaging MethodsFaculty of Medicine in Pilsen, Charles UniversityAlej Svobody 80Pilsen30460Czech Republic
| | - Vaclav Liska
- Department of SurgeryFaculty of Medicine in PilsenCharles UniversityAlej Svobody 923/80Pilsen32300Czech Republic
- Biomedical CenterFaculty of Medicine in PilsenCharles UniversityAlej Svobody 1655/76Pilsen32300Czech Republic
| | - Inge K. Herrmann
- Nanoparticle Systems Engineering LaboratoryInstitute of Energy and Process Engineering (IEPE)Department of Mechanical and Process Engineering (D‐MAVT)ETH ZurichSonneggstrasse 3Zürich8092Switzerland
- Particles‐Biology InteractionsDepartment of Materials Meet LifeSwiss Federal Laboratories for Materials Science and Technology (Empa)Lerchenfeldstrasse 5St. Gallen9014Switzerland
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Klicova M, Rosendorf J, Erben J, Horakova J. Antiadhesive Nanofibrous Materials for Medicine: Preventing Undesirable Tissue Adhesions. ACS OMEGA 2023; 8:20152-20162. [PMID: 37323398 PMCID: PMC10268260 DOI: 10.1021/acsomega.3c00341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/10/2023] [Indexed: 06/17/2023]
Abstract
Undesirable postoperative tissue adhesions remain among the most common complications after surgery. Apart from pharmacological antiadhesive agents, various physical barriers have been developed in order to prevent postoperative tissue adhesions. Nevertheless, many introduced materials suffer from shortcomings during in vivo application. Thus, there is an increasing need to develop a novel barrier material. However, various challenging criteria have to be met, so this issue pushes the research in materials to its current limits. Nanofibers play a major role in breaking the wall of this issue. Due to their properties, such as a large surface area for functionalization, tunable degradation rate, or the possibility of layering individual nanofibrous materials, it is feasible to create an antiadhesive surface while maintaining biocompatibility. There are many ways to produce nanofibrous material; electrospinning is the most used and versatile technique. This review reveals the different approaches and puts them into context.
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Affiliation(s)
- Marketa Klicova
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, 461 17 Liberec, Czech Republic
| | - Jachym Rosendorf
- Biomedical
Center, Faculty of Medicine in Pilsen, Charles
University, Alej Svobody
1655/76, 323 00 Plzen, Czech Republic
| | - Jakub Erben
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, 461 17 Liberec, Czech Republic
| | - Jana Horakova
- Department
of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 2, 461 17 Liberec, Czech Republic
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5
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Kural T, Grajciarová M, Rosendorf J, Pálek R, Červenková L, Malečková A, Šarčevic S, Liška V, Tonar Z. Histological mapping of healing of the small and large intestine – a quantitative study in a porcine model. Ann Anat 2023; 249:152095. [PMID: 37011825 DOI: 10.1016/j.aanat.2023.152095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/02/2023] [Accepted: 03/22/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Gastrointestinal anastomoses are performed in many patients every year. The pathogenesis of aberrant anastomotic healing and the causes of intestinal leakage are not fully understood. The present study gathered and critically evaluated histological quantitative data to deepen current knowledge of anastomotic healing in the small and large intestine and its complications and outline the options for further experimental in vivo research in large porcine animal models. METHODS Three groups of porcine intestinal anastomoses were compared: small intestine without defect (SI; n=7), small intestine with an additional defect (SID; n=8), and large intestine (LI; n=7). Multilevel sampling (2,112 micrographs) and stereological methods were used for histological quantification of proliferation (Ki-67 immunohistochemistry), neutrophil infiltration (myeloperoxidase staining), vascularity (von Willebrand factor) and type I and type III collagen formation (picrosirius red in polarized light) within the region of anastomosis compared to the region outside of anastomosis. RESULTS Quantitative histological evaluation revealed the following results. i) Proliferation, vascularity, and collagen, but not neutrophils, were more highly expressed within the anastomosis than outside of the anastomosis region. ii) Porcine large and small intestine were not interchangeable based on histological evaluation of surgical experiments. The presence or absence of an additional experimental defect strongly affected healing, but the healing seemed complete after 21 days. iii) The microscopic structure of small intestine segments was more affected by their proximity to the anastomosis than the structure of large intestine segments. CONCLUSIONS Histological quantification was more laborious than the previously used semiquantitative scoring system evaluating the healing rate of intestinal anastomoses, but it provided detailed maps of biological processes within individual intestine layers. The primary data collected in the study are open and available for power sample analyses to calculate the minimum numbers of samples justified in future experiments on porcine intestines. The porcine intestine is a promising animal model with translational potential for human surgery.
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6
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Kralovic M, Vjaclovsky M, Tonar Z, Grajciarova M, Lorenzova J, Otahal M, Necas A, Hoch J, Amler E. Nanofiber Fractionalization Stimulates Healing of Large Intestine Anastomoses in Rabbits. Int J Nanomedicine 2022; 17:6335-6345. [PMID: 36540375 PMCID: PMC9759981 DOI: 10.2147/ijn.s364888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/04/2022] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND A current topic of ma jor interest in regenerative medicine is the development of novel materials for accelerated healing of sutures, and nanofibers seem to be suitable materials for this purpose. As various studies have shown, nanofibers are able to partially substitute missing extracellular matrix and to stimulate cell proliferation and differentiation in sutures. Therefore, we tested nanofibrous membranes and cryogenically fractionalized nanofibers as potential materials for support of the healing of intestinal anastomoses in a rabbit model. MATERIALS AND METHODS We compared cryogenically fractionalized chitosan and PVA nanofibers with chitosan and PVA nanofiber membranes designed for intestine anastomosis healing in a rabbit animal model. The anastomoses were biomechanically and histologically tested. RESULTS In strong contrast to nanofibrous membranes, the fractionalized nanofibers did show positive effects on the healing of intestinal anastomoses in rabbits. The fractionalized nanofibers were able to reach deep layers that are key to increased mechanical strength of the intestine. Moreover, fractionalized nanofibers led to the formation of collagen-rich 3D tissue significantly exceeding the healing effects of the 2D flat nanofiber membranes. In addition, the fractionalized chitosan nanofibers eliminated peritonitis, significantly stimulated anastomosis healing and led to a higher density of microvessels, in addition to a larger fraction of myofibroblasts and collagen type I and III. Biomechanical tests supported these histological findings. CONCLUSION We concluded that the fractionalized chitosan nanofibers led to accelerated healing for rabbit colorectal anastomoses by the targeted stimulation of collagen-producing cells in the intestine, the smooth muscle cells and the fibroblasts. We believe that the collagen-producing cells were stimulated both directly due to the presence of a biocompatible scaffold providing cell adhesion, and indirectly, by a proper stimulation of immunocytes in the suture.
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Affiliation(s)
- Martin Kralovic
- Quality of Indoor Environment, University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Bustehrad, Czech Republic
- Department of Biophysics, Second Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Michal Vjaclovsky
- Department of Surgery, Motol University Hospital, Prague, Czech Republic
| | - Zbynek Tonar
- Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Martina Grajciarova
- Department of Histology and Embryology and Biomedical Centre, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Jana Lorenzova
- Section of Small Animal Diseases, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Brno, Czech Republic
| | - Martin Otahal
- Department of Natural Sciences, Faculty of Biomedical Engineering in Kladno, Czech Technical University in Prague, Prague, Czech Republic
| | - Alois Necas
- Section of Small Animal Diseases, Faculty of Veterinary Medicine, University of Veterinary Sciences Brno, Brno, Czech Republic
| | - Jiri Hoch
- Department of Surgery, Motol University Hospital, Prague, Czech Republic
- Department of Surgery, Second Medical Faculty, Charles University in Prague, Prague, Czech Republic
| | - Evzen Amler
- Quality of Indoor Environment, University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Bustehrad, Czech Republic
- Department of Biophysics, Second Medical Faculty, Charles University in Prague, Prague, Czech Republic
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7
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Kolinko Y, Malečková A, Kochová P, Grajciarová M, Blassová T, Kural T, Trailin A, Červenková L, Havránková J, Vištejnová L, Tonarová P, Moulisová V, Jiřík M, Zavaďáková A, Tichánek F, Liška V, Králíčková M, Witter K, Tonar Z. Using virtual microscopy for the development of sampling strategies in quantitative histology and design-based stereology. Anat Histol Embryol 2021; 51:3-22. [PMID: 34806204 DOI: 10.1111/ahe.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 10/31/2021] [Indexed: 02/03/2023]
Abstract
Only a fraction of specimens under study are usually selected for quantification in histology. Multilevel sampling or tissue probes, slides and fields of view (FOVs) in the regions of interest (ROIs) are required. In general, all parts of the organs under study should be given the same probability to be taken into account; that is, the sampling should be unbiased on all levels. The objective of our study was to provide an overview of the use of virtual microscopy in the context of developing sampling strategies of FOVs for stereological quantification. We elaborated this idea on 18 examples from multiple fields of histology, including quantification of extracellular matrix and muscle tissue, quantification of organ and tumour microvessels and tumour-infiltrating lymphocytes, assessing osseointegration of bone implants, healing of intestine anastomoses and osteochondral defects, counting brain neurons, counting nuclei in vitro cell cultures and others. We provided practical implications for the most common situations, such as exhaustive sampling of ROIs, sampling ROIs of different sizes, sampling the same ROIs for multiple histological methods, sampling more ROIs with variable intensities or using various objectives, multistage sampling and virtual sampling. Recommendations were provided for pilot studies on systematic uniform random sampling of FOVs as a part of optimizing the efficiency of histological quantification to prevent over- or undersampling. We critically discussed the pros and cons of using virtual sections for sampling FOVs from whole scanned sections. Our review demonstrated that whole slide scans of histological sections facilitate the design of sampling strategies for quantitative histology.
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Affiliation(s)
- Yaroslav Kolinko
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Anna Malečková
- Faculty of Applied Sciences, European Centre of Excellence NTIS, University of West Bohemia, Pilsen, Czech Republic
| | - Petra Kochová
- Faculty of Applied Sciences, European Centre of Excellence NTIS, University of West Bohemia, Pilsen, Czech Republic
| | - Martina Grajciarová
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Tereza Blassová
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Tomáš Kural
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Andriy Trailin
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Lenka Červenková
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic.,Department of Pathology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiřina Havránková
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Lucie Vištejnová
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Pavla Tonarová
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Vladimíra Moulisová
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Miroslav Jiřík
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic.,Faculty of Applied Sciences, European Centre of Excellence NTIS, University of West Bohemia, Pilsen, Czech Republic
| | - Anna Zavaďáková
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Filip Tichánek
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic.,Department of Pathological Physiology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Václav Liška
- Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic.,Department of Surgery and Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Milena Králíčková
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
| | - Kirsti Witter
- Institute of Morphology, Department of Pathobiology, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Zbyněk Tonar
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic.,Faculty of Medicine in Pilsen, Biomedical Center, Charles University, Pilsen, Czech Republic
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8
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Alverdy JC, Schardey HM. Anastomotic Leak: Toward an Understanding of Its Root Causes. J Gastrointest Surg 2021; 25:2966-2975. [PMID: 34100248 PMCID: PMC8815793 DOI: 10.1007/s11605-021-05048-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/18/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND When an anastomotic leak is discussed at a typical surgical morbidity and mortality conference, it is often presented as a due to an error in surgical technique involving ischemia, tension, or device failure. Here we assert that without direct visual analysis of the leak site and its tissue histology, an ex post facto claim that an anastomotic leak is due to an error in surgical technique remains speculative. METHODS The arguments and rationale used to conclude that an anastomotic leak is due to an error in surgical technique are critically reviewed and assessed for their validity. RESULTS No case series or literature exists in which a root cause analysis has been carried out with visual and tissue level evidence to determine the root cause(s) of an anastomotic leak. CONCLUSIONS At the individual case level, declaring that an anastomotic leak is due to an error in surgical technique without clear and compelling evidence either visually and/or at the tissue level to substantiate such a claim remains speculative.
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Affiliation(s)
- John C Alverdy
- Department of Surgery, University of Chicago, Pritzker School of Medicine, 5841 S. Maryland, Chicago, IL, 60637, USA,Corresponding author
| | - Hans Martin Schardey
- Department of General, Visceral, and Transplantation Surgery, Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany and Department of General, Visceral and Vascular Surgery, Agatharied Hospital, Norbert-Kerkel-Platz, 83734, Hausham, Germany
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9
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Rosendorf J, Klicova M, Cervenkova L, Palek R, Horakova J, Klapstova A, Hosek P, Moulisova V, Bednar L, Tegl V, Brzon O, Tonar Z, Treska V, Lukas D, Liska V. Double-layered Nanofibrous Patch for Prevention of Anastomotic Leakage and Peritoneal Adhesions, Experimental Study. In Vivo 2021; 35:731-741. [PMID: 33622866 PMCID: PMC8045053 DOI: 10.21873/invivo.12314] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Anastomotic leakage is a feared complication in colorectal surgery. Postoperative peritoneal adhesions can also cause life-threatening conditions. Nanofibrous materials showed their pro-healing properties in various studies. The aim of the study was to evaluate the impact of double-layered nanofibrous materials on anastomotic healing and peritoneal adhesions formation. MATERIALS AND METHODS Two versions of double-layered materials from polycaprolactone and polyvinyl alcohol were applied on defective anastomosis on the small intestine of healthy pigs. The control group remained with uncovered defect. Tissue specimens were subjected to histological analysis and adhesion scoring after 3 weeks of observation. RESULTS The wound healing was inferior in the experimental groups, however, no anastomotic leakage was observed and the applied material always kept covering the defect. The extent of adhesions was larger in the experimental groups. CONCLUSION Nanofibrous materials may prevent anastomotic leakage but delay healing.
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Affiliation(s)
- Jachym Rosendorf
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic;
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Marketa Klicova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Liberec, Czech Republic
| | - Lenka Cervenkova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- Department of Pathology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Palek
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Jana Horakova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Liberec, Czech Republic
| | - Andrea Klapstova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Liberec, Czech Republic
| | - Petr Hosek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Vladimira Moulisova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Lukas Bednar
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Vaclav Tegl
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine in Plzen, Pilsen, Czech Republic
| | - Ondrej Brzon
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Zbynek Tonar
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- Department of Histology and Embryology, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Vladislav Treska
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - David Lukas
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Liberec, Czech Republic
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Vaclav Liska
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
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10
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Rosendorf J, Klicova M, Cervenkova L, Horakova J, Klapstova A, Hosek P, Palek R, Sevcik J, Polak R, Treska V, Chvojka J, Liska V. Reinforcement of Colonic Anastomosis with Improved Ultrafine Nanofibrous Patch: Experiment on Pig. Biomedicines 2021; 9:102. [PMID: 33494257 PMCID: PMC7909771 DOI: 10.3390/biomedicines9020102] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/12/2023] Open
Abstract
Anastomotic leakage is a dreadful complication in colorectal surgery. It has a negative impact on postoperative mortality, long term life quality and oncological results. Nanofibrous polycaprolactone materials have shown pro-healing properties in various applications before. Our team developed several versions of these for healing support of colorectal anastomoses with promising results in previous years. In this study, we developed highly porous biocompatible polycaprolactone nanofibrous patches. We constructed a defective anastomosis on the large intestine of 16 pigs, covered the anastomoses with the patch in 8 animals (Experimental group) and left the rest uncovered (Control group). After 21 days of observation we evaluated postoperative changes, signs of leakage and other complications. The samples were assessed histologically according to standardized protocols. The material was easy to work with. All animals survived with no major complication. There were no differences in intestinal wall integrity between the groups and there were no signs of anastomotic leakage in any animal. The levels of collagen were significantly higher in the Experimental group, which we consider to be an indirect sign of higher mechanical strength. The material shall be further perfected in the future and possibly combined with active molecules to specifically influence the healing process.
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Affiliation(s)
- Jachym Rosendorf
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Marketa Klicova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Lenka Cervenkova
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
| | - Jana Horakova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Andrea Klapstova
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Petr Hosek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
| | - Richard Palek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Jan Sevcik
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
| | - Robert Polak
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Vladislav Treska
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
| | - Jiri Chvojka
- Department of Nonwovens and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, 460 01 Liberec, Czech Republic; (M.K.); (J.H.); (A.K.); (J.C.)
| | - Vaclav Liska
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic; (L.C.); (P.H.); (R.P.); (J.S.); (R.P.)
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, 301 00 Pilsen, Czech Republic;
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Horakova J, Klicova M, Erben J, Klapstova A, Novotny V, Behalek L, Chvojka J. Impact of Various Sterilization and Disinfection Techniques on Electrospun Poly-ε-caprolactone. ACS OMEGA 2020; 5:8885-8892. [PMID: 32337451 PMCID: PMC7178787 DOI: 10.1021/acsomega.0c00503] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 03/31/2020] [Indexed: 05/20/2023]
Abstract
Electrospun materials made from biodegradable polycaprolactone are used widely in various tissue engineering and regenerative medicine applications because of their morphological similarity to the extracellular matrix. However, the main prerequisite for the use of such materials in clinical practice consists of the selection of the appropriate sterilization technique. This study is devoted to the study of the impact of traditional sterilization and disinfection methods on a nanofibrous polycaprolactone layer constructed by means of the needleless electrospinning technique. It was determined that hydrogen peroxide plasma treatment led to the loss of fibrous morphology and the creation of a foil. However, certain sterilization (ethylene oxide, gamma irradiation, and peracetic acid) and disinfection techniques (ethanol and UV irradiation) were found not to lead to a change in morphology; thus, the study investigates their impact on thermal properties, molecular weight, and interactions with a fibroblast cell line. It was determined that the surface properties that guide cell adhesion and proliferation were affected more than the bulk properties. The highest proliferation rate of fibroblasts seeded on nanofibrous scaffolds was observed with respect to gamma-irradiated polycaprolactone, while the lowest proliferation rate was observed following ethylene oxide sterilization.
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Affiliation(s)
- Jana Horakova
- Department of Nonwovens
and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 1402/2, 460 01 Liberec, Czech Republic
| | - Marketa Klicova
- Department of Nonwovens
and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 1402/2, 460 01 Liberec, Czech Republic
| | - Jakub Erben
- Department of Nonwovens
and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 1402/2, 460 01 Liberec, Czech Republic
| | - Andrea Klapstova
- Department of Nonwovens
and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 1402/2, 460 01 Liberec, Czech Republic
| | - Vit Novotny
- Department of Nanomaterials in Natural
Sciences, Institute of Nanomaterials, Advanced Technologies and Innovation, Technical University of Liberec, Studentska 1402/2, 460 01 Liberec, Czech Republic
| | - Lubos Behalek
- Department of Engineering Technology, Faculty
of Mechanical Engineering, Technical University
of Liberec, Studentska 1402/2, 460 01 Liberec, Czech Republic
| | - Jiri Chvojka
- Department of Nonwovens
and Nanofibrous Materials, Faculty of Textile Engineering, Technical University of Liberec, Studentska 1402/2, 460 01 Liberec, Czech Republic
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