Experimental evaluation of a bovine pericardium-derived collagen matrix buttress in ileocolic and colon anastomoses.
BACKGROUND
Anastomotic leakage is a major complication of colorectal surgery. The purpose of this study was to evaluate and compare stapled ileocolic and colon-colon anastomoses with or without a collagen buttress derived from bovine pericardium in the immediate postoperative period.


METHODS
Various stapling devices were used to create ileocolic and colon-colon anastomoses in a canine model. Ileocolic anastomoses were created by simulating two different techniques: "open" and "laparoscopic". Colon-colon anastomoses were created by using a double-stapled technique. A total of 27 colon anastomoses (13 left colon-colon, 8 right "laparoscopic", and 6 right "open") were created. Anastomoses buttressed with bovine pericardium (n = 15) were compared to anastomoses without any reinforcement (n = 12). Staple lines were evaluated 4 hours after operation. Evaluation included bursting pressure and bursting location.


RESULTS
No stapler device malfunction occurred. Excision rings were complete in all colon-colon anastomoses. All non-buttressed anastomoses burst at the staple line, whereas with buttressed anastomoses the adjacent intestine burst (p = 0.0001). The intestinal bursting pressure of bowel segments with buttressed staple lines (mean, 362 mmHg) was significantly higher than the bursting pressure of non-buttressed staple lines (mean, 204 mmHg, p < 0.0001).


CONCLUSIONS
The use of a collagen matrix buttress derived from bovine pericardium in stapled ileocolic and colon-colon anastomoses was safe. Buttressed anastomoses showed greater bursting strength as compared to non-buttressed anastomoses in the immediate postoperative period in a canine model.
Gaertner
Wolfgang B
WB
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA. gaert015@umn.edu
Hagerman
Gonzalo F
GF
Potter
Michael J
MJ
Karulf
Richard E
RE
D000714:Anastomosis, Surgical; D000818:Animals; D002417:Cattle; D003094:Collagen / Q000737:chemistry*; D003106:Colon / Q000601:surgery*; D004285:Dogs; D005260:Female; D007082:Ileum / Q000601:surgery*; D010496:Pericardium / Q000737:chemistry*
D003094:Collagen