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Intestinal anastomoses detected with a photopolymerized hydrogel
Thomas Sweeney1, Sunil Rayan, Henry Warren
1Harvard Center for Minimally Invasive Surgery, Department of Surgery, Massachusetts General Hospital, Boston, 02114, USA.
Background:
This study examines the efficacy of a novel, absorbable photopolymerized hydrogel sealant, Focalseal (Focal Inc, Lexington, Mass), in protecting high-risk suture deficient intestinal anastomoses (HRA) compared with conventional sutured anastomoses (CSA).
Methods:
Twenty-four New Zealand white rabbits were either randomized to small bowel HRA constructed with 4 interrupted 5/0 polyglyconate sutures and treated with Focalseal or small bowel CSA constructed with 8 to 10 interrupted 5/0 polyglyconate sutures. Four rabbits from each group were killed at postoperative days 3, 7, and 21. Anastomoses were assessed for evidence of dehiscence, adhesion formation, stenosis, and bursting pressure; they were also examined histologically for collagen content estimation and blood vessel formation.
Results:
Mean operative time was 35 minutes (SD 5) for CSA and 35 minutes (SD 5) for HRA. There was 1 postoperative death in the HRA group. A postmortem examination revealed no evidence of anastomotic leak. The remaining 23 animals were assessed as planned. There was no evidence of anastomotic dehiscence in any animal. There was no significant difference in adhesion formation (P =.09), stenosis (P =.6), or bursting pressure (P =.2) between HRA and CSA groups. Collagen (P =.007) and blood vessel (P =.002) formation were significantly increased in HRA.
Conclusions:
HRA treated with Focalseal heal well and have similar strength to CSA. This technique may prove valuable in procedures such as laparoscopic bowel resection.