title: Is collagen a good banding material for outlet control of vertical gastroplasty? Preliminary study in pigs.
abstract: BACKGROUND
  To maintain the long-term effects of a gastric bariatric operation, bands are often placed to control the restriction. Erosion into the gastric wall by these devices remains a problem. A soft resiliant prosthesis of animal origin, constituted by a network of non-absorbable collagen fibres, may be a solution to this problem. This study assessed, in a porcine model, the histological reaction of the gastric wall following apposition of a band of porcine collagen (Pelvicol, Bard).
  
  
  METHODS
  15 female pigs weighing on average 21 kg underwent vertical banded gastroplasty (VBG). Stoma control was achieved with a band of porcine collagen (2 cm wide, 7 cm long and 2 mm thick). The pigs were sacrificed 1 month after VBG, and histological analysis was performed at a macroscopic and microscopic level.
  
  
  RESULTS
  There was no peri-operative death, although 2 pigs died in the postoperative period (the first case developed a bowel fistula and sepsis, and the second pig died of unrelated causes). There were 2 additional morbidities (gastric fistula on the linear staple-line away from the Pelvicol band) that led to an early euthanasia of 2 pigs. Post-mortem macroscopic analyses in the remaining 11 pigs did not reveal migration of the device, and there was no tissue reaction on postoperative microscopic analyses. 10 of the pigs had lost weight at 1 month, averaging 3.42 kg.
  
  
  CONCLUSIONS
  Porcine collagen appears to be an effective and safe alternative to the current methods of control of pouch outlet. The flexibility and homogeneity of this prosthesis may be useful to limit the risk of erosion of the gastric wall. Although these properties have been assessed in pelvic operations in humans, this work needs to be studied in a prospective long-term study in humans.
authors.affiliation: Digestive Surgery Center, Montpellier Hospital, France, and Weill College of Medicine of Cornell University, New York, USA. d.nocca@wanadoo.fr
authors.forename: David
authors.initials: D
authors.lastname: Nocca
authors.forename: Michel
authors.initials: M
authors.lastname: Gagner
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Eric
authors.initials: E
authors.lastname: Deneve
authors.forename: Bertrand
authors.initials: B
authors.lastname: Millat
authors.forename: Didier
authors.initials: D
authors.lastname: Pourquier
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Fabre
mesh_terms: D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use*; D001705:Bioprosthesis; D003094:Collagen / Q000627:therapeutic use*; D005260:Female; D015391:Gastroplasty / Q000295:instrumentation*; D023421:Models, Animal; D011475:Prosthesis Failure; D019919:Prosthesis Implantation / Q000295:instrumentation; D013552:Swine
chemical_list: D001672:Biocompatible Materials; D003094:Collagen