Sutureless primary repair of colonic perforation with a degradable stent in a porcine model of fecal peritonitis.
OBJECTIVE
Colonic perforation with fecal peritonitis is a life-threatening clinical condition. For these patients, a two-stage operation of fecal diversion and a postponed colostomy closure is generally recommended. Accordingly, a simple and feasible primary repair technique was explored.


METHODS
A sutureless banding method using a biodegradable stent and a porcine model of artificial colonic perforation were introduced. The colonic perforation model was created successfully with an open procedure in 34 pigs. The primary repair with a stent or the conventional hand-sewn control was performed 72 h later. Morbidity and mortality were recorded. Pigs in each group were also sacrificed to evaluate the healing on postoperative days (PODs) 3, 7, 14, and 90. The peripheral white blood cell counts, albumin, anastomotic bursting pressure, hydroxyproline contents, and histology data were evaluated.


RESULTS
There were 17 pigs in either group. Four pigs (23.5 %) of the control group died, but no mortality occurred in the stent group. There were no significant differences in white blood cell counts and albumin. Though anastomotic hydroxyproline contents between the two groups were comparable, the collagen per protein ratio on POD 14 in the stent group was higher, as well as the bursting pressure on PODs 3 and 7. Microscopically, the local inflammation of the cut edges in the control group was more severe, and the collagen synthesis started later.


CONCLUSIONS
A sutureless primary repair of a colonic perforation with a degradable stent is a feasible method in a porcine model of fecal peritonitis.
Department of Hepatobiliary Surgery, Qingdao Municipal Hospital, Ocean University of China, Qingdao, China.
Kun
K
Liu
Hong
H
Yu
Minghui
M
Zhang
Yichen
Y
Yu
Yifan
Y
Wang
Xiujun
X
Cai
D000418:Albumins / Q000378:metabolism; D000818:Animals; D001672:Biocompatible Materials / Q000494:pharmacology; D003094:Collagen / Q000378:metabolism; D003106:Colon / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D004195:Disease Models, Animal; D005243:Feces / Q000382:microbiology; D005260:Female; D006909:Hydroxyproline / Q000378:metabolism; D007416:Intestinal Perforation / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D007958:Leukocyte Count; D008297:Male; D061646:Operative Time; D010538:Peritonitis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011312:Pressure; D015203:Reproducibility of Results; D015607:Stents; D016019:Survival Analysis; D034421:Sus scrofa; D013537:Sutures; D000267:Tissue Adhesions / Q000150:complications / Q000473:pathology; D014945:Wound Healing / Q000187:drug effects
D000418:Albumins; D001672:Biocompatible Materials; D003094:Collagen; D006909:Hydroxyproline