Bovine pericardium buttress limits recanalization of the uncut Roux-en-Y in a porcine model

In contrast to the traditional Roux-en-Y reconstruction, an uncut Roux-en-Y provides biliopancreatic diversion and may preserve myoelectric continuity. Previous iterations of the uncut Roux have been plagued by recanalization of the uncut staple line in the afferent small bowel. Our aim was to determine if bovine pericardium buttress prevents recanalization of the stapled small bowel partition in a porcine model. Sixteen female pigs ( approximately 30 kg) underwent a side-to-side stapled jejunojejunostomy, 20 cm distal to the ligament of Treitz, with placement of a nondivided stapled partition with a single row of 2.5 mm width staples in the intervening jejunal loop. Nine animals in the experimental group had a bovine pericardium buttressed staple line (5 permanent, 4 absorbable), whereas seven animals in the control group had a nonbuttressed staple line. At 6 or 12 weeks, necropsy was performed and the primary outcome, staple line recanalization, was assessed grossly and histologically. Statistical analysis was performed by means of the chi-square test. There were no major complications and all animals gained weight. Overall, eight of nine bovine pericardium buttressed staple lines were grossly and histologically intact at necropsy, whereas all nonbuttressed uncut staple lines had recanalized completely (P<0.05). At 6 weeks, both permanent (N=4) and absorbable (N=3) buttress preparations prevented recanalization. At 12 weeks the permanent buttress remained closed (N=1), but the absorbable buttress had allowed partial recanalization (N=1). The use of bovine pericardium buttress will prevent small bowel recanalization of uncut small bowel staple lines at early follow-up. Pilot data at intermediate follow-up suggest permanent buttress is more durable than absorbable buttress. These results warrant investigation of bovine pericardium for intestinal applications in humans.