Buttressing Staples with Cholecyst-derived Extracellular Matrix (CEM) Reinforces Staple Lines in an Ex Vivo Peristaltic Inflation Model

Overview

Journal Obes Surg

Date 2008 May 7

PMID 18459017

Citations 5

Authors

Krishna Burugapalli

Jeffrey C Y Chan

John L Kelly

Abhay Pandit

Affiliations

Soon will be listed here.

Abstract

Background: Staple line leakage and bleeding are the most common problems associated with the use of surgical staplers for gastrointestinal resection and anastomotic procedures. These complications can be reduced by reinforcing the staple lines with buttressing materials. The current study reports the potential use of cholecyst-derived extracellular matrix (CEM) in non-crosslinked (NCEM) and crosslinked (XCEM) forms, and compares their mechanical performance with clinically available buttress materials [small intestinal submucosa (SIS) and bovine pericardium (BP)] in an ex vivo small intestine model.

Methods: Three crosslinked CEM variants (XCEM0005, XCEM001, and XCEM0033) with different degree of crosslinking were produced. An ex vivo peristaltic inflation model was established. Porcine small intestine segments were stapled on one end, using buttressed or non-buttressed surgical staplers. The opened, non-stapled ends were connected to a peristaltic pump and pressure transducer and sealed. The staple lines were then exposed to increased intraluminal pressure in a peristaltic manner. Both the leak and burst pressures of the test specimens were recorded.

Results: The leak pressures observed for non-crosslinked NCEM (137.8 +/- 22.3 mmHg), crosslinked XCEM0005 (109.1 +/- 14.1 mmHg), XCEM001 (150.1 +/- 16.0 mmHg), XCEM0033 (98.8 +/- 10.5 mmHg) reinforced staple lines were significantly higher when compared to non-buttressed control (28.3 +/- 10.8 mmHg) and SIS (one and four layers) (62.6 +/- 11.8 and 57.6 +/- 12.3 mmHg, respectively) buttressed staple lines. NCEM and XCEM were comparable to that observed for BP buttressed staple lines (138.8 +/- 3.6 mmHg). Only specimens with reinforced staple lines were able to achieve high intraluminal pressures (ruptured at the intestinal mesentery), indicating that buttress reinforcements were able to withstand pressure higher than that of natural tissue (physiological failure).

Conclusions: These findings suggest that the use of CEM and XCEM as buttressing materials is associated with reinforced staple lines and increased leak pressures when compared to non-buttressed staple lines. CEM and XCEM were found to perform comparably with clinically available buttress materials in this ex vivo model.

Citing Articles

A porcine-cholecyst-derived scaffold for treating full thickness lacerated skin wounds in dogs.

Karthika S, Anoop S, Devanand C, Narayanan M, Unni M, Eassow S Vet Res Commun. 2018; 42(3):233-242.

PMID: 30069619 DOI: 10.1007/s11259-018-9731-3.

Use of bioabsorbable staple reinforcement material in side-to-side anastomoses: Suture line reinforcement of the weak point of the anastomosis.

Kimura M, Terashita Y Ann Med Surg (Lond). 2016; 6:50-5.

PMID: 27158487 PMC: 4843102. DOI: 10.1016/j.amsu.2016.01.034.

Bubaline Cholecyst Derived Extracellular Matrix for Reconstruction of Full Thickness Skin Wounds in Rats.

Shakya P, Sharma A, Kumar N, Vellachi R, Mathew D, Dubey P Scientifica (Cairo). 2016; 2016:2638371.

PMID: 27127678 PMC: 4835655. DOI: 10.1155/2016/2638371.

Porcine cholecyst-derived scaffold promotes full-thickness wound healing in rabbit.

Revi D, Vineetha V, Muhamed J, Rajan A, Anilkumar T J Tissue Eng. 2014; 4:2041731413518060.

PMID: 24555014 PMC: 3927752. DOI: 10.1177/2041731413518060.

Extracellular matrices for gastrointestinal surgery: ex vivo testing and current applications.

Hoeppner J, Marjanovic G, Helwig P, Hopt U, Keck T World J Gastroenterol. 2010; 16(32):4031-8.

PMID: 20731016 PMC: 2928456. DOI: 10.3748/wjg.v16.i32.4031.

References

Ahmed S, Marzouk K, Bhuiya T, Iqbal M, Rossoff L . Asymptomatic expectoration of surgical staples complicating lung volume reduction surgery. Chest. 2001; 119(1):307-8. DOI: 10.1378/chest.119.1.307. View

Consten E, Gagner M . Perioperative outcome of laparoscopic left lateral liver resection is improved by using staple line reinforcement technique: a case report. J Gastrointest Surg. 2005; 9(3):360-4. DOI: 10.1016/j.gassur.2004.07.016. View

Brewer C, Chan J, Kurosaki T, Berman M . Radical hysterectomy with the endoscopic stapler. Gynecol Oncol. 1998; 71(1):50-2. DOI: 10.1006/gyno.1998.5096. View

Burugapalli K, Pandit A . Characterization of tissue response and in vivo degradation of cholecyst-derived extracellular matrix. Biomacromolecules. 2007; 8(11):3439-51. DOI: 10.1021/bm700560k. View

Stammberger U, Klepetko W, Stamatis G, Hamacher J, Schmid R, Wisser W . Buttressing the staple line in lung volume reduction surgery: a randomized three-center study. Ann Thorac Surg. 2001; 70(6):1820-5. DOI: 10.1016/s0003-4975(00)01903-2. View

Nguyen N, Longoria M, Chalifoux S, Wilson S . Bioabsorbable staple line reinforcement for laparoscopic gastrointestinal surgery. Surg Technol Int. 2006; 14:107-11. View

Lustosa S, Matos D, Atallah A, Castro A . Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev. 2001; (3):CD003144. DOI: 10.1002/14651858.CD003144. View

Potaris K, Mihos P, Gakidis I . Experience with an albumin-glutaraldehyde tissue adhesive in sealing air leaks after bullectomy. Heart Surg Forum. 2004; 6(5):429-33. View

Coburn J, Brody S, Billiar K, Pandit A . Biaxial mechanical evaluation of cholecyst-derived extracellular matrix: a weakly anisotropic potential tissue engineered biomaterial. J Biomed Mater Res A. 2007; 81(1):250-6. DOI: 10.1002/jbm.a.30943. View

10.

Downey D, Michel M, Harre J, Pratt J . Functional assessment of a new staple line reinforcement in lung resection. J Surg Res. 2005; 131(1):49-52. DOI: 10.1016/j.jss.2005.06.007. View

11.

Downey D, Harre J, Dolan J . Increased burst pressure in gastrointestinal staple-lines using reinforcement with a bioprosthetic material. Obes Surg. 2005; 15(10):1379-83. DOI: 10.1381/096089205774859254. View

12.

Pinheiro J, Correa J, Cohen R, Novaes J, Schiavon C . Staple line reinforcement with new biomaterial increased burst strength pressure: an animal study. Surg Obes Relat Dis. 2006; 2(3):397-9, discussion 400. DOI: 10.1016/j.soard.2006.03.006. View

13.

Eisenkop S, Spirtos N . Division of pedicles by stapling during cytoreductive surgery for ovarian cancer. Gynecol Oncol. 2005; 97(3):852-7. DOI: 10.1016/j.ygyno.2005.03.001. View

14.

Awais O, Raftopoulos I, Luketich J, Courcoulas A . Acute, complete proximal small bowel obstruction after laparoscopic gastric bypass due to intraluminal blood clot formation. Surg Obes Relat Dis. 2006; 1(4):418-22. DOI: 10.1016/j.soard.2005.04.004. View

15.

Burugapalli K, Thapasimuttu A, Chan J, Yao L, Brody S, Kelly J . Scaffold with a natural mesh-like architecture: isolation, structural, and in vitro characterization. Biomacromolecules. 2007; 8(3):928-36. DOI: 10.1021/bm061088x. View

16.

de la Portilla F, Zbar A, Rada R, Vega J, Cisneros N, Maldonado V . Bioabsorbable staple-line reinforcement to reduce staple-line bleeding in the transection of mesenteric vessels during laparoscopic colorectal resection: a pilot study. Tech Coloproctol. 2006; 10(4):335-8. DOI: 10.1007/s10151-006-0303-0. View

17.

Choy P, Bissett I, Docherty J, Parry B, Merrie A . Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2007; (3):CD004320. DOI: 10.1002/14651858.CD004320.pub2. View

18.

Suter M, Paroz A, Calmes J, Giusti V . European experience with laparoscopic Roux-en-Y gastric bypass in 466 obese patients. Br J Surg. 2006; 93(6):726-32. DOI: 10.1002/bjs.5336. View

19.

Matsumoto I, Ohta Y, Oda M, Tsunezuka Y, Tamura M, Kawakami K . Free pericardial fat pads can act as sealant for preventing alveolar air leaks. Ann Thorac Surg. 2005; 80(6):2321-4. DOI: 10.1016/j.athoracsur.2005.04.077. View

20.

Shamji M, Maziak D, Shamji F, Matzinger F, Perkins D . Surgical staple metalloptysis after apical bullectomy: a reaction to bovine pericardium?. Ann Thorac Surg. 2002; 74(1):258-61. DOI: 10.1016/s0003-4975(02)03541-5. View