title: Collagen fleeces do not improve colonic anastomotic strength but increase bowel obstructions in an experimental rat model.
abstract: OBJECTIVE
  To investigate whether a collagen fleece kept in place by fibrin glue might seal off a colorectal anastomosis, provide reinforcement, and subsequently improve anastomotic healing.
  
  
  METHODS
  Wistar rats underwent a 1-cm left-sided colonic resection followed by a 4-suture end-to-end anastomosis. They were then randomly assigned to one of three treatment groups: no additional intervention (control, n = 20), the anastomosis covered with fibrin glue (fibrin glue, n = 20), the anastomosis covered with a collagen fleece, kept in place with fibrin glue (collagen fleece, n = 21). At either 3 or 7 days follow-up, anastomotic bursting pressure was measured and tissue was obtained for histology and collagen content assessment after which animals were sacrificed.
  
  
  RESULTS
  Three rats in the control (15%), three in the fibrin glue (15%), and one in the collagen group (4.8%) died due to anastomotic complications (P = 0.497). Anastomotic bursting pressures were not significantly different between groups at 3 and 7 days follow-up (P = 0.659 and P = 0.427, respectively). However, bowel obstructions occurred significantly more often in the collagen group compared to the control group (14/21 vs. 3/20, P = 0.003). Collagen contents were not different between groups, but histology showed a more severe inflammation in the collagen group compared to the other groups at both 3 and 7 days follow-up.
  
  
  CONCLUSIONS
  A collagen fleece kept in place by fibrin glue does not improve healing of colonic anastomoses in rats. Moreover, this technique induces significantly more bowel obstructions in rats, warranting further study before being translated to a clinical setting.
authors.affiliation: Department of General Surgery, Maastricht University Medical Centre, PO Box 5800, 6200 Maastricht, The Netherlands. m.schreinemacher@gmail.com
authors.forename: Marc H
authors.initials: MH
authors.lastname: Schreinemacher
authors.forename: Johanne G
authors.initials: JG
authors.lastname: Bloemen
authors.forename: Stijn J
authors.initials: SJ
authors.lastname: van der Heijden
authors.forename: Marion J
authors.initials: MJ
authors.lastname: Gijbels
authors.forename: Cornelis H
authors.initials: CH
authors.lastname: Dejong
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Bouvy
mesh_terms: D000714:Anastomosis, Surgical; D000818:Animals; D003094:Collagen / Q000009:adverse effects*; D003106:Colon / Q000601:surgery*; D004195:Disease Models, Animal; D007415:Intestinal Obstruction / Q000139:chemically induced* / Q000473:pathology; D008297:Male; D011312:Pressure; D051381:Rats; D017208:Rats, Wistar
chemical_list: D003094:Collagen