title: Anastomotic sealing by extracellular matrices (ECM) improves healing of colonic anastomoses in the critical early phase.
abstract: BACKGROUND
  Extracellular matrices have proven potential for in vivo tissue regeneration at gastrointestinal luminal organs. In this study, small intestinal submucosa (SIS) was tested as a sealant for colonic anastomoses in a rodent model.
  
  
  METHODS
  In the rodent model, standard colonic anastomoses in the control group (CG; n = 30) and anastomoses sealed by omentum (n = 30) were compared to SIS-sealed anastomoses in the study group (SG; n = 30). After 4-, 30-, and 90-day macroscopic and microscopic healing, bursting pressure and anastomotic stricture rate were evaluated.
  
  
  RESULTS
  The rate of anastomotic dehiscence was 1/10 after 4 days and 0/10 after 30 and 90 days in all groups. In the SG, the bursting pressure was significantly increased after 4 days compared to CG (148 +/- 9 vs. 108 +/- 8 mmHg; p > 0.05). Histologically, after 4 days of neovascularization, fibroblast ingrowth and collagen deposition were significantly increased in SG compared to CG. After 30 days, nonsignificant differences were noted in all three parameters. Adhesion rate and anastomotic stricture rate were not significantly affected by SIS sealing after 4, 30, and 90 days.
  
  
  CONCLUSIONS
  Especially in the critical phase of anastomotic healing up to day 4, anastomotic healing was improved by SIS sealing. SIS sealing did not cause long-term complications.
authors.affiliation: Department for General and Visceral Surgery, University of Freiburg, Hugstettter Str 55, 79106 Freiburg, Germany. jens.hoeppner@uniklinik-freiburg.de
authors.forename: Jens
authors.initials: J
authors.lastname: Hoeppner
authors.forename: Bettina
authors.initials: B
authors.lastname: Wassmuth
authors.forename: Goran
authors.initials: G
authors.lastname: Marjanovic
authors.forename: Sylvia
authors.initials: S
authors.lastname: Timme
authors.forename: Ulrich Theodor
authors.initials: UT
authors.lastname: Hopt
authors.forename: Tobias
authors.initials: T
authors.lastname: Keck
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D001696:Biomechanical Phenomena; D003094:Collagen / Q000494:pharmacology*; D003106:Colon / Q000473:pathology / Q000601:surgery*; D005109:Extracellular Matrix; D007421:Intestine, Small; D008297:Male; D023421:Models, Animal; D009852:Omentum; D051381:Rats; D017208:Rats, Wistar; D013997:Time Factors; D014014:Tissue Adhesives / Q000494:pharmacology*; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D014014:Tissue Adhesives; D003094:Collagen