Polyurethane-based tissue adhesive for sealing pancreatic anastomosis: a pig model

Pancreatic anastomosis is a critical step in partial pancreatoduodenectomy, as failure of the anastomosis with postoperative pancreatic fistula can lead to high morbidity and mortality. While various fibrin-based sealing agents have been tested, their effectiveness is limited due to rapid degradation by pancreatic secretions. This study aimed to evaluate the applicability and biocompatibility of a novel biodegradable, polyurethane-based adhesive (VIVO 120™) for intraoperative sealing of pancreatic anastomoses in a long-term survival pig model.

An in vitro investigation of VIVO 120™ resistance to pancreatic enzymes over 21 days and an in vivo application for sealing a simplified pancreatogastrostomy were conducted. Following pancreatic tail resection, a simplified pancreatogastrostomy was performed in 12 pigs, sealing the anastomosis between the pancreatic body and the gastric wall with VIVO 120™. One pig underwent acute testing (1-day survival), and 11 pigs were included in a long-term survival study (14-day survival). Animals were divided into three groups based on adhesive application: Group 1 (intraluminal application, n = 4), Group 2 (extraluminal application, n = 3), and Group 3 (intraluminal application with pancreatic duct obstruction and superficial pressure injection into the pancreatic resection plane, n = 4). Clinical observations, laboratory diagnostics, necropsy, and histological analyses were performed.

VIVO 120™ exhibited high resistance to enzymatic degradation. Histology revealed no adhesive remnants in Group 1, whereas in Group 2, the adhesive was integrated into the surrounding connective tissue. Both groups showed signs of only very mild pancreatitis distant to the adhesive, likely resulting from surgical trauma, and no signs of pancreatic fistula, while Group 3 exhibited severe pancreatitis and extensive fibroblastic proliferation following pressure application.

VIVO 120™ is biocompatible and resistant to pancreatic secretions, suggesting its potential for effective sealing of pancreatic anastomoses. However, application with pressure into pancreatic tissue should be avoided to prevent severe pancreatitis and extensive fibroblastic proliferation.