Bovine pericardium buttress reinforces colorectal anastomoses in a canine model.
OBJECTIVE
The consequences of an anastomotic leak or disruption can be devastating, particularly in the colorectal surgery population. The purpose of this study was to evaluate and compare colon anastomoses with or without a collagen matrix buttress derived from bovine pericardium.


METHODS
A circular stapler was used to create colon-colon anastomoses in a canine model. Twenty animals underwent two anastomoses each: one buttressed with bovine pericardium, and one without any reinforcement. Staple lines were evaluated at Days 0, 3, 7, 14, 42, and 84. Three animals were killed at each time interval, and evaluation included bursting pressure, bursting location, and histology.


RESULTS
Colon segments with nonbuttressed anastomoses were more likely to burst at the staple line (63 percent), whereas buttressed anastomoses were more likely to burst at the adjacent intestine (74 percent; P=0.048). The burst pressure of nonbuttressed staple lines tended to be consistently, although not significantly, higher than the burst pressure of buttressed staple lines (P=0.651). At histologic analysis, the bovine pericardium buttress demonstrated an ability to allow cellular ingrowth at Day 3 and neovascularization at Day 7. There was no evidence of stenosis or infection.


CONCLUSIONS
The use of a collagen matrix buttress in colorectal anastomoses was safe in a canine model. Our study indicates that true burst strength of the majority of buttressed anastomoses was greater than the adjacent intestine.
Hagerman
Gonzalo F
GF
Division of Colon and Rectal Surgery, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA.
Gaertner
Wolfgang B
WB
Ruth
George R
GR
Potter
Michael L
ML
Karulf
Richard E
RE
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D002417:Cattle; D003106:Colon / Q000166:cytology / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004285:Dogs; D005260:Female; D010496:Pericardium / Q000637:transplantation*; D012007:Rectum / Q000166:cytology / Q000601:surgery*; D015203:Reproducibility of Results; D013536:Suture Techniques / Q000295:instrumentation*