Use of collagen wrap from bovine origin for the management of colic perforation. Preliminary study in a pig model.
BACKGROUND
The prevention or the management of digestive fistulae may be performed by using an external wrap of collagen of animal origin. To evaluate this treatment, an experimental study creating a hole in the colon of pig covered by a resorbable collagen belt was performed. Results are very interesting and collagen wrap is very well tolerated by the colon wall.


BACKGROUND
Digestive perforations, whether colorectal, jejunal, esophageal, or biliodigestive, are common emergency situations and can threaten the patient's condition or extend their hospital stay. The evolution of biomaterials of animal origin, and the biocompatibility proven after some human surgical procedures, have led our team to propose an experimental study in a pig model to treat colic perforation by positioning a resorbable bilayer collagen band of bovine origin over the area of an experimental hole.


METHODS
A first group of 10 pigs was operated upon, and a 1 cm2 hole was experimentally created in the distal part of the colon. Then, a belt of resorbable collagen sponge joined to a collagen film, from bovine origin, was placed and fixed around the outer part of the colon to cover the fistula without closing the hole by sutures. After an average of two weeks, all the animals were sacrificed. The abdominal cavity was examined in a macroscopic and microscopic manner. A second group of 10 pigs was tested under a different protocol to assess the efficiency of the bowel wrap prosthesis in a septic field.


RESULTS
In the first group of pigs, there were no complications during the procedures. The mortality rate was zero during this period. No pig was operated on urgently to manage an acute complication. The complication rate was 10% due to one wound infection. The macroscopic examinations of the explanted colon articles didn't find any stricture under the prosthesis location for the 10 pigs. Local smooth adhesions were noted in 7 pigs (70%). Among the second group of pigs, the mortality rate was 10% due to a myocardial infarction during the period of peritonitis. No pig was operated on urgently to manage an acute complication. The complication rate was 20% due to 2 wound infections. The macroscopic examination of the explanted colon articles found one case of stricture under the prosthesis location (10%). Local smooth adhesions were noted in 7 pigs (70%). No histologic rejection was noted during the anatomopathologic tests for all pigs.


CONCLUSIONS
The use of bovine collagen bilayer prosthesis in digestive surgery may prove to be safe and effective to treat digestive leakage. It may be feasible to use this type of biomaterial to prevent fistula of the digestive tract, including anastomotic. A prospective trial would need to be performed to complete this research to give the surgeons an opportunity to improve treatment in many digestive procedures.
Nocca
David
D
University Hospital Center Montpellier, Faculty of Medicine, Montpellier, France. d.nocca@wanadoo.fr
Aggarwal
Rajesh
R
Deneve
Eric
E
Picot
Marie Christine
MC
Sanders
Grant
G
Pourquier
Didier
D
Taillade
H
H
Millat
B
B
Gagner
Michel
M
Fabre
J M
JM
D000818:Animals; D001672:Biocompatible Materials / Q000627:therapeutic use*; D001705:Bioprosthesis; D002417:Cattle; D003094:Collagen / Q000627:therapeutic use*; D003106:Colon / Q000601:surgery*; D004195:Disease Models, Animal; D005260:Female; D007416:Intestinal Perforation / Q000601:surgery*; D019919:Prosthesis Implantation / Q000379:methods*; D013552:Swine
D001672:Biocompatible Materials; D003094:Collagen