Use of Collagen Wrap from Bovine Origin for the Management of Colic Perforation. Preliminary Study in a Pig Model
The prevention or the management of digestive fistulae may be performed by using an external wrap of collagen of animal origin. To evaluate this treatment, an experimental study creating a hole in the colon of pig covered by a resorbable collagen belt was performed. Results are very interesting and collagen wrap is very well tolerated by the colon wall.
Digestive perforations, whether colorectal, jejunal, esophageal, or biliodigestive, are common emergency situations and can threaten the patient's condition or extend their hospital stay. The evolution of biomaterials of animal origin, and the biocompatibility proven after some human surgical procedures, have led our team to propose an experimental study in a pig model to treat colic perforation by positioning a resorbable bilayer collagen band of bovine origin over the area of an experimental hole.
A first group of 10 pigs was operated upon, and a 1 cm2 hole was experimentally created in the distal part of the colon. Then, a belt of resorbable collagen sponge joined to a collagen film, from bovine origin, was placed and fixed around the outer part of the colon to cover the fistula without closing the hole by sutures. After an average of two weeks, all the animals were sacrificed. The abdominal cavity was examined in a macroscopic and microscopic manner. A second group of 10 pigs was tested under a different protocol to assess the efficiency of the bowel wrap prosthesis in a septic field.
In the first group of pigs, there were no complications during the procedures. The mortality rate was zero during this period. No pig was operated on urgently to manage an acute complication. The complication rate was 10% due to one wound infection. The macroscopic examinations of the explanted colon articles didn't find any stricture under the prosthesis location for the 10 pigs. Local smooth adhesions were noted in 7 pigs (70%). Among the second group of pigs, the mortality rate was 10% due to a myocardial infarction during the period of peritonitis. No pig was operated on urgently to manage an acute complication. The complication rate was 20% due to 2 wound infections. The macroscopic examination of the explanted colon articles found one case of stricture under the prosthesis location (10%). Local smooth adhesions were noted in 7 pigs (70%). No histologic rejection was noted during the anatomopathologic tests for all pigs.
The use of bovine collagen bilayer prosthesis in digestive surgery may prove to be safe and effective to treat digestive leakage. It may be feasible to use this type of biomaterial to prevent fistula of the digestive tract, including anastomotic. A prospective trial would need to be performed to complete this research to give the surgeons an opportunity to improve treatment in many digestive procedures.
Available from: Mario Testini
- "In particularly, the available experimental data showed that the mechanical anastomoses buttressed with bovine pericardium ,  or small intestinal submucosa had greater bursting strength as compared to non-buttressed anastomoses ,  and a wound healing improvement ,  has been demonstrated. Moreover, a colic perforation treated by positioning a resorbable bilayer collagen band of bovine origin in a pig model showed results very encouraging . "
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ABSTRACT: Failure of intestinal anastomosis is a major complication following abdominal surgery. Biological materials have been introduced as reinforcement of abdominal wall hernia in contaminated setting. An innovative application of biological patch is its use as reinforcement of gastrointestinal anastomosis. The aim of study was to verify whether the bovine pericardium patch improves the healing of anastomosis, when in vivo wrapping the suture line of pig intestinal anastomosis, avoiding leakage in the event of deliberately incomplete suture. Forty-three pigs were randomly divided: Group 1 (control, n = 14): hand-sewn ileo-ileal and colo-colic anastomosis; Group 2 (n = 14): standard anastomosis wrapped by pericardium bovine patch; Group 3 (n = 1) and 4 (n = 14): one suture was deliberately incomplete and also wrapped by patch in the last one. Intraoperative evaluation, histological, biochemical, tensiometric and electrophysiological studies of intestinal specimens were performed at 48 h, 7 and 90 days after. In groups 2 and 4, no leak, stenosis, abscess, peritonitis, mesh displacement or shrinkage were found and adhesion rate decreased compared to control. Biochemical studies showed mitochondrial function improvement in colic wrapped anastomosis. Tensiometric evaluations suggested that the patch preserves the colic contractility similar to the controls. Electrophysiological results demonstrated that the patch also improves the mucosal function restoring almost normal transport properties. Use of pericardium bovine patch as reinforcement of intestinal anastomosis is safe and effective, significantly improving the healing process. Data of prevention of acute peritonitis and leakage in cases of iatrogenic perforation of anastomoses, covered with patch, is unpublished.
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ABSTRACT: Gastrointestinal tissue engineering has emerged over the past 20 years and was often focused on esophagus, stomach or small intestine, whereas bioengineering researches of colorectal tissue are scarce. However, some promising results have been obtained in animal models. Refinements should be performed in scaffold and cell source selection to allow smooth muscle layer regeneration. Indeed, synthetic and natural polymers such as small intestinal submucosa and collagen sponge seeded with organoid units or smooth muscle cells did not allow smooth muscle regeneration. Mesenchymal stem cells derived from adipose tissue seeded on composite scaffold could represent an interesting way to achieve this goal. This article reviews potential indications, current status and perspectives of tissue engineering in the area of colorectal surgery.
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