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Zhang B, Li X, Jiang C, Wang C, Que H, Zheng C, Ji Z, Tao X, Xu H, Shi C. Construction of PVA/OHA-Gs@PTMC/PHA double-layer nanofiber flexible scaffold with antibacterial function for tension free rectal in-situ reconstruction. Biomaterials 2025; 317:123064. [PMID: 39754964 DOI: 10.1016/j.biomaterials.2024.123064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 11/25/2024] [Accepted: 12/26/2024] [Indexed: 01/06/2025]
Abstract
The effective prevention and treatment of anastomotic leakage after intestinal anastomosis for colorectal diseases is still a major clinical challenge. In order to assist intestinal anastomosis healing and avoid anastomotic leakage caused by high tension, low blood supply or infection, we designed a double-layer nanofiber intestinal anastomosis scaffold, which was composed of electrospun PTMC/PHA nanofibers as the main layer, and electrospun PVA/OHA-Gs nanofibers with antibacterial properties as the antibacterial surface layer. This double-layer scaffold has good toughness, its maximum tensile force value could reach 8 N, elongation could reach 400 %, and it has hydrophilic properties, and its contact angle was about 60°. On the basis of reducing anastomotic tension and isolating intestinal contents, this double-layer nanofiber anastomotic scaffold not only played an antibacterial effect in the short term after surgery to reduce inflammatory response, but also had the characteristics of multiple three-dimensional network structure like extracellular matrix which could promote tissue healing. The PVA/OHA-Gs@PTMC/PHA scaffold was implanted into a rabbit model simulating mechanical intestinal obstruction, and the results showed that the nanofibers of the scaffold could be degraded in vivo while maintaining a certain stability, that is, the overall structure of the PVA/OHA-Gs@PTMC/PHA scaffold would not shrink and deform due to degradation in a certain period of time. Therefore, the treatment with this scaffold showed better healing at the anastomotic site. Compared to the direct anastomosis group and pure PTMC scaffold group, the double-layer scaffold group promoted a faster return to normal anastomotic strength within 7 days. This PVA/OHA-Gs@PTMC/PHA double-layer nanofiber flexible scaffold appears to be a promising therapeutic strategy to prevent anastomotic leakage after intestinal anastomosis.
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Affiliation(s)
- Bingxu Zhang
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China
| | - Xujian Li
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China
| | - Chuan Jiang
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Chuanguang Wang
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Haifeng Que
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Cheng Zheng
- Department of Critical Care Medicine, Taizhou Municipal Hospital, Taizhou, Zhejiang, 318000, China
| | - Zhixiao Ji
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China
| | - Xudong Tao
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China
| | - Hongtao Xu
- Department of Gastrointestinal Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, Zhejiang, China.
| | - Changcan Shi
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou, Zhejiang, 325011, China.
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Ge X, Jin Y, Liu W, Tong Y, Wan Z, Qi W, Zhou W, Cai X. Safety and feasibility of the KONO-S anastomosis technique with biodegradable stent in Crohn's disease: a pilot study. Int J Colorectal Dis 2025; 40:98. [PMID: 40263180 PMCID: PMC12014815 DOI: 10.1007/s00384-025-04885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/05/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND AND AIMS The KONO-S (antimesenteric functional end-to-end handsewn) anastomosis has been used for Crohn's disease (CD) recently, with its efficacy in reducing the risk of anastomotic surgical recurrence. However, the anastomotic leakage is also found in CD with this technique. This study aims to evaluate the safety and feasibility of the KONO-S anastomosis with biodegradable stent in CD. METHODS We performed a study of 56 CD patients undergoing bowel resection by the KONO-S anastomosis technique with or without biodegradable stent. Postoperative complications, time to first flatus, time to first defecation, and healing of the anastomosis were recorded, especially in patients receiving biodegradable stent. RESULT The study included 24 CD patients receiving KONO-S anastomosis with biodegradable stent and 32 patients receiving normal KONO-S anastomosis. In patients with biodegradable stent, 8 patients received small bowel resection, 15 received ileocecal resection, and 1 received colectomy; the mean time for the new anastomosis technique was 15.8 ± 2.0 min. No stent-related complications were observed postoperatively. The time to first flatus and defecation was 2.3 ± 0.5 days and 3.7 ± 0.8 days in patients with biodegradable stent, respectively. All the stents degraded at almost 4-5 weeks after surgery. The colonoscopy showed that the healing condition of the anastomosis was good without any recurrence during 6-month follow-up in the stent group. CONCLUSION This is a pilot study that showed that the KONO-S anastomosis technique with biodegradable stent was safe and feasible in CD with lower risk of anastomotic complications and no serious adverse events.
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Affiliation(s)
- Xiaolong Ge
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Yujie Jin
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Wei Liu
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Yifan Tong
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhe Wan
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Weilin Qi
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
| | - Wei Zhou
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China.
| | - Xiujun Cai
- Department of General Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, China
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Hao R, Wang W, Ma Y, Chen J, Li Y, Yang Y, Ma D, Zhang Z. Clinical using of innovative biodegradable stent with extension sleeve in Ta_tme for low rectal cancer with high risk of anastomotic leakage. Sci Rep 2025; 15:6797. [PMID: 40000647 PMCID: PMC11862227 DOI: 10.1038/s41598-024-73935-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 09/23/2024] [Indexed: 02/27/2025] Open
Abstract
The objective of this paper is to observe and evaluate the safety and feasibility of using a degradable colorectal endoluminal stent with extension sleeve(DCESES) in patients at high risk of anastomotic leakage following low anterior resection (LAR) for rectal cancer using the transanal total mesorectal excision (Ta_tme) technique. Six patients with low rectal cancer undergoing Ta_tme surgery and identified as high risk for anastomotic leakage were selected. During surgery, the tumor was mobilized transanally and excised outside the anus. A suitable biodegradable stent was chosen and connected to a sterile extension sleeve. The stent was fixed with absorbable sutures 5 cm proximal to the intestinal cut end. Anastomosis was then completed at the anus, and the extension sleeve was pulled through the anus to externalize, diverting fecal matter and preventing contact with the anastomotic site. None of the six patients underwent a prophylactic ileostomy. All six patients successfully underwent Ta_tme surgery with the implantation of the biodegradable colorectal endoluminal stent with an extension sleeve. Within 3-4 weeks postoperatively, the stent disintegrated into fragments and was expelled through the anus along with the plastic sleeve. All patients experienced no significant perianal discomfort, anastomotic leakage, anastomotic stricture, or other complications during the perioperative period. Fecal diversion using a biodegradable stent with an extension sleeve in high-risk patients for anastomotic leakage following Ta_tme is safe and feasible. This approach effectively prevents complications such as anastomotic leakage and stricture during Ta_tme, avoiding the need for prophylactic ileostomy and its associated complications, thereby reducing patient suffering, saving medical resources, lowering medical costs, and improving patient quality of life.
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Affiliation(s)
- Rongrong Hao
- Department of Occupational Health (Key Laboratory of Electromagnetic Radiation Protection Ministry of Education), Third Military Medical University, Chongqing, 400038, China
| | - Wensheng Wang
- Department of general surgery, Xinqiao Hospital, The Army Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Yuanhang Ma
- Department of general surgery, Xinqiao Hospital, The Army Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Jianghong Chen
- Chongqing Public Health Medical Center, Chongqing, 400036, China
| | - Yunbo Li
- Department of general surgery, Xinqiao Hospital, The Army Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Yang Yang
- Department of general surgery, Xinqiao Hospital, The Army Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing, 400037, China
| | - Dan Ma
- Department of general surgery, Xinqiao Hospital, The Army Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing, 400037, China.
| | - Zhicao Zhang
- Department of general surgery, Xinqiao Hospital, The Army Medical University, No. 183, Xinqiao Street, Shapingba District, Chongqing, 400037, China
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Luchtefeld M, Jrebi N, Hostetter G, Osterholzer K, Dykema K, Khoo SK. Effect of Doxycycline-Release Anastomotic Augmentation Ring on Porcine Colorectal Anastomosis. J Surg Res 2022; 279:464-473. [PMID: 35842971 DOI: 10.1016/j.jss.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/17/2022] [Accepted: 05/21/2022] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Collagen degradation can lead to early postoperative weakness in colorectal anastomosis. Matrix metalloproteinase inhibitors (MMPIs) are shown to decrease collagen breakdown and enhance healing in anastomosis in animal models. Here, we evaluated the effectiveness of a novel anastomotic augmentation ring (AAR) that releases doxycycline, an MMPI, from a poly(lactic-co-glycolic) acid ring in porcine anastomoses. METHODS Two end-to-end stapled colorectal anastomoses were performed in 20 Yorkshire-Hampshire pigs. AAR was randomly incorporated into either the proximal or distal anastomosis as treatment, while nonaugmented anastomosis served as a control. Animals were then euthanized on days 3, 4, and 5 before anastomosis explantation and burst pressure measurement. Each anastomosis site was also collected for histology, hydroxyproline content, and gene expression microarray analyses. RESULTS No abscess or anastomotic leak was detected. Average burst pressures were not significantly different at any time point. There is no statistical difference in collagen content between the treatment group and controls. Gene expression analysis revealed no statistically significant in differentially expressed genes. However, genes related to inflammation, such as C-C motif chemokine ligand 11 (CCL11), CD70, and C-X-C motif chemokine ligand 10 (CXCL10), were upregulated (not statistically significant) in AAR compared to non-AAR anastomosis sites on days 3 and 4. CONCLUSIONS This pilot study shows that doxycycline-release AAR is feasible and safe. While burst pressure and collagen content did not change significantly with doxycycline treatment, upregulating genes related to the inflammatory process for pathogen and debris clearance in AAR may improve the early stage of colorectal anastomotic healing.
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Affiliation(s)
| | - Nezar Jrebi
- Spectrum Health, Grand Rapids, Michigan; North Texas Surgical Specialists, Fort Worth, Texas
| | - Galen Hostetter
- Pathology and Biorepository Core, Van Andel Institute, Grand Rapids, Michigan
| | | | | | - Sok Kean Khoo
- Department of Cell and Molecular Biology, Grand Valley State University, Allendale, Michigan.
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Chen M, Cao J, Huang D, Zhang B, Pan L, Zhang Z, Wang Z, Ye Y, Xiu D, Li D, Cai X. End-to-end intestinal anastomosis using a novel biodegradable stent for laparoscopic colonic surgery: a multicenter study. Surg Today 2019; 49:1003-1012. [PMID: 31256255 DOI: 10.1007/s00595-019-01841-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Our animal studies have demonstrated the safety and feasibility of end-to-end intestinal anastomosis using a stent for laparoscopic colonic surgery. Therefore, we designed a non-inferiority trial to investigate the outcomes of stent anastomosis (SA) vs. those of conventional hand-sewn anastomosis (CA). METHODS A multicenter randomized controlled trial was conducted between December, 2016 and April, 2018. The primary outcome was the healing condition of the anastomoses, evaluated by endoscopy 6 months postoperatively. The secondary outcomes were the anastomotic completion time, anastomotic leak, intestinal obstruction, peritoneal effusion, and bleeding. Quality of life (QOL) was evaluated by questionnaires. RESULTS The subjects of this study were 60 patients, randomly divided into a SA group (n = 30) and a CA group (n = 30). There were no differences in anastomotic healing conditions (P = 1.00). The stent procedure was associated with a significantly shorter anastomosis time than the hand-sewn anastomosis (13.517 ± 4.281 vs. 20.333 ± 2.998 min, respectively; P < 0.001). There were no significant differences in anastomotic leakage, intestinal obstruction, peritoneal effusion, or bleeding between the groups. Questionnaires revealed almost no discrepancy between baseline QOL scores and those assessed 2, 4, 8, 12, and 24 weeks postoperatively in either group. CONCLUSIONS Intestinal anastomosis with a stent is a non-inferior strategy for laparoscopic colonic surgery, which requires less time for the anastomosis.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Diyu Huang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100032, China
| | - Zhenjun Wang
- Department of Anorectal Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, 100032, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100089, China
| | - Dechuan Li
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310011, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China.
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China.
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Mosafer Khoorjestan S, Rouhi G. An Automatic Suturing Machine for Intestinal Anastomosis: Advantages Compared With Hand-Suturing Technique. Surg Innov 2018; 26:209-218. [PMID: 30362888 DOI: 10.1177/1553350618808007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the main procedures in intestinal surgery is anastomosis, which is mostly performed by stapling or hand suturing. Due to limitations of these methods, a novel automatic suturing machine was designed and fabricated in this study, equipped with a needle-driving system; a thread control mechanism, and a linear mechanism, which is applicable in intestinal anastomosis by making continuous sutures. The main advantages of the fabricated machine are employing biocompatible suture, from the tissue's adaptation point of view, and making a uniform suturing pattern, independent of surgeon's skill, and thus offering a greater strength than the hand-sutured specimen. In order to evaluate the capability of the fabricated machine and investigate the validity of the hypothesis made in this study, that is, a more uniform suture will result in a greater mechanical strength of the sutured tissue, in vitro tests were performed on human intestine specimens, which were manually sutured by an expert surgeon and by the automatic suturing machine. The tensile tests with an elongation rate of 5 mm/min were done for 90 specimens, in 9 groups with various suturing configurations. The optimum pattern, from the mechanical strength point of view, was found to be the same in both manual and automatic suturing methods, that is, h7 d6 ( h = distance of suture from the edge of the tissue = 7 mm, and d = distance between stitches = 6 mm). It was also shown that the maximum breaking strength, for the best suturing pattern, h7 d6, is significantly greater when the automatic suturing machine was employed, compared with the hand-sutured tissue ( P < .001).
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Khoorjestan SM, Rouhi G, Toolabi K. An investigation of the effects of suture patterns on mechanical strength of intestinal anastomosis: an experimental study. BIOMED ENG-BIOMED TE 2017; 62:429-437. [PMID: 27639265 DOI: 10.1515/bmt-2016-0103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/27/2016] [Indexed: 11/15/2022]
Abstract
How the distance of sutures from the edge of tissue and the horizontal distance between stitches affect the mechanical strength of anastomosis is investigated. In this study, 180 bovine intestines were used to investigate the optimum pattern in 18 groups by considering a 4, 6, and 8 mm horizontal distance between stitches, and a 3, 5, and 7 mm distance from the edge of tissue with 3-0 Silk and 3-0 PDS sutures to maximize the strength of anastomosis (10 specimens in each group). Also, 80 specimens were used to investigate the maximum effective distance of sutures from the edge of tissue in eight groups of: 3, 5, 7, and 10 mm distance from the edge, with the same type of sutures. Tensile tests with an elongation rate of 5 mm/min were performed for all the groups. Based on the results, the pattern of 7-6 (distance from the edge-distance between stitches) for both 3-0 Silk and 3-0 PDS, 5-6 and 7-4 for 3-0 Silk, and 5-6 and 7-4 for 3-0 PDS can be considered as the best options among 18 different combinations. It was also found that increasing the distance from the edge from 7 mm to 10 mm does not cause a significant difference in mechanical strength. Results can help surgeons to improve the intestinal anastomosis and employ it as an input for automatic suturing devices.
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Paonessa S, Barbani N, Rocchietti EC, Giachino C, Cristallini C. Design and development of a hybrid bioartificial water-induced shape memory polymeric material as an integral component for the anastomosis of human hollow organs. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2017; 75:1427-1434. [PMID: 28415434 DOI: 10.1016/j.msec.2017.03.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/29/2016] [Accepted: 03/04/2017] [Indexed: 11/28/2022]
Abstract
A large number of pathologies require the resection of the bowel and anastomoses to rejoin the two remaining stumps to regain lumen patency. Various materials have been used to rejoin one bowel end to the other such as catgut, stainless steel, and absorbable sutures. The present method for anastomosis surgery uses an entero-entero anastomosis (EEA) circular stapler with only a staple line. This method can have some drawbacks, such as intracellular fluid leakage and local inflammations. The aim of this study is to design and develop a novel bioartificial polymer with a ring shape made of polyvinyl alcohol (PVA) and gelatin (80/20 ratio (w/w)) loaded both directly with acetylsalicylic acid and with nanoparticles incorporating the same drug to reduce local inflammation even for a prolonged period of time. A physical method (8cycles freezing/thawing) was used to obtain a crosslinked bioartificial shape memory ring. Mechanical analysis showed a storage modulus having a comparable value with that of the human colon. HPLC analysis pointed out a sustained and prolonged release of the anti-inflammatory drug both immediately after anastomosis surgery and during healing period. Cell culture tests indicated the cytocompatibility of the bioartificial device. A shape memory of the hydrogel prepared in ring form was observed at 37°C after immersion in water. These bioartificial devices can represent a new approach to serve as a multifunctional anastomotic ring.
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Affiliation(s)
- Siriana Paonessa
- Department of Civil and Industrial Engineering, University of Pisa, Pisa 56122, Italy
| | - Niccoletta Barbani
- Department of Civil and Industrial Engineering, University of Pisa, Pisa 56122, Italy
| | | | - Claudia Giachino
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, Turin 10043, Italy
| | - Caterina Cristallini
- Institute for Chemical and Physical Processes, IPCF, C.N.R., Pisa, 56122, Italy.
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KHOORJESTAN SANAZMOSAFER, ROUHI GHOLAMREZA, TOOLABI KARAMOLLAH. EXPERIMENTAL INVESTIGATIONS ON INTESTINAL ANASTOMOSIS — A COMPARISON BETWEEN AUTOMATIC AND HAND SUTURING TECHNIQUES. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this research, intestinal anastomosis was compared in hand and automatic suturing. This work is based on two different experiments: The first one is the tensile test with the aim of finding the maximum breaking strength with the elongation rate of 5[Formula: see text]mm/min; and the second one is the fatigue test with a frequency of 0.2[Formula: see text]Hz and the amplitude of 16, 24 and 32[Formula: see text]mm of stretch in each phase to discover the total number of cycles to failure. For this purpose, 42 fresh bovine intestines were used; 21 specimens for the tensile and 21 for the fatigue test. These two tests were compared by two hand sewing techniques: simple continuous and ford interlocking stitches, and one automatic technique, i.e., the lock stitches. Seven samples were examined for each particular technique. The results of the tensile test indicated that the breaking strength of automatic sutured specimens is significantly greater than those of hand sutured specimens ([Formula: see text]). That might be due to the regularity, as the suturing lines by machines are more regular than suturing by hand. In addition, results showed that automatic sutured specimens failed in greater number of cycles than hand sutured specimens in the fatigue test ([Formula: see text]).
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Affiliation(s)
| | - GHOLAMREZA ROUHI
- Faculty of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - KARAMOLLAH TOOLABI
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Ma L, Cai XJ, Wang HH, Yu YL, Huang DY, Ge GJ, Hu HY, Yu SC. Laparoscopic colonic anastomosis using a degradable stent in a porcine model. World J Gastroenterol 2016; 22:4707-4715. [PMID: 27217702 PMCID: PMC4870077 DOI: 10.3748/wjg.v22.i19.4707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023] Open
Abstract
AIM: To explore the feasibility and safety of laparoscopic colonic anastomosis using a degradable stent in a porcine model.
METHODS: Twenty Bama mini-pigs were randomly assigned to a stent group (n = 10) and control group (hand-sewn anastomosis, n = 10). The anastomotic completion and operation times were recorded, along with histological examination, postoperative general condition, complications, mortality, bursting pressure, and the average anastomotic circumference (AC).
RESULTS: All pigs survived postoperatively except for one in the stent group that died from ileus at 11 wk postoperatively. The operation and anastomotic completion times of the stent group were significantly shorter than those of the control group (P = 0.004 and P = 0.001, respectively). There were no significant differences in bursting pressure between the groups (P = 0.751). No obvious difference was found between the AC and normal circumference in the stent group, but AC was significantly less than normal circumference in the control group (P = 0.047, P < 0.05). No intestinal leakage and luminal stenosis occurred in the stent group. Histological examination revealed that the stent group presented with lower general inflammation and better healing.
CONCLUSION: Laparoscopic colonic anastomosis with a degradable stent is a simple, rapid, and safe procedure in this porcine model.
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Kim EJ, Kim YJ. Stents for colorectal obstruction: Past, present, and future. World J Gastroenterol 2016; 22:842-852. [PMID: 26811630 PMCID: PMC4716082 DOI: 10.3748/wjg.v22.i2.842] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 10/22/2015] [Accepted: 11/19/2015] [Indexed: 02/06/2023] Open
Abstract
Since the development of uncovered self-expanding metal stents (SEMS) in the 1990s, endoscopic stents have evolved dramatically. Application of new materials and new designs has expanded the indications for enteral SEMS. At present, enteral stents are considered the first-line modality for palliative care, and numerous types of enteral stents are under development for extended clinical usage, beyond a merely palliative purpose. Herein, we will discuss the current status and the future development of lower enteral stents.
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12
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Changes of the colonic physiologic functions after colonic anastomosis with a degradable stent in a porcine model. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Wang Y, Cai X, Mei J, Liu K, Cai X. Colonic anastomosis with a doxycycline-coated stent: an experimental study in a porcine model. Dig Surg 2014; 31:87-94. [PMID: 24776716 DOI: 10.1159/000358811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Accepted: 01/15/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) are supposed to be potential drug targets to prevent leakage after colonic anastomosis. A method of colonic anastomosis by using a stent coated with doxycycline, a MMP inhibitor, was developed and its safety and feasibility, as well as the effect of locally regulating MMPs, were evaluated by comparing with the conventional method or the method with a doxycycline-free stent. METHODS 48 pigs were assigned randomly to doxycycline-coated stent anastomosis group (DSA), doxycycline-free stent anastomosis group (SA), or conventional anastomosis group (CA). In each group, pigs were subdivided into four subgroups according to postoperative observation time (3, 7, 14, and 30 days). Healing of anastomosis and expressions of MMP-2/9 were evaluated. RESULTS No anastomotic leakage, stricture or necrosis was observed in the DSA group. No significant difference of bursting pressure was found between the DSA group and SA group. Relative expression of MMP-2 in the DSA group was significantly lower than in the SA group on postoperative days 3 and 7. No significant differences of hydroxyproline content, microvessel density and TGF-β1 level were found in these groups. CONCLUSION These results suggested this method was feasible and safe for colonic anastomosis with the advantage of locally inhibiting MMPs.
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Affiliation(s)
- YiFan Wang
- Department of Surgery, Sir Run Run Shaw Hospital of Zhejiang University, Hangzhou, China
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Wang Y, Liang Y, Wang W, Jin R, Cai X. Management of electrothermal injury of common bile duct with a degradable biliary stent: an experimental study in a porcine model. J Gastrointest Surg 2013; 17:1760-5. [PMID: 23949424 DOI: 10.1007/s11605-013-2316-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 08/02/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Electrothermal injury of common bile duct is a frequent type of biliary injury. A long-term postoperative course and biliary leakage after removing T-tube are associated with external drainage. A method was developed to repair the injury with a degradable biliary stent instead of T-tube insertion. METHODS Pigs were divided into a stent repair (SR) group (n = 18), a T-tube repair (TR) group (n = 4), and a suturing repair (SUR) group (n = 4). An electrothermal injury model was made by electric coagulation. Pigs in the SR group were further divided into five subgroups according to the observation time (2 weeks and 1, 3, 6, and 18 months). Pigs in the TR group and SUR group were observed for 6 months. Cholangiography was repeated and bilirubin level was monitored. Pigs were reoperated for further evaluation at the end of observation. RESULTS No biliary stricture, bile leakage, or bile duct necrosis occurred in the SR group. The stent could be detected in the first 2 months. No stent migration or stent-related obstruction was observed. Three pigs in the SUR group had biliary stricture with elevated bilirubin levels. CONCLUSIONS These results suggested that the developed method for repairing electrothermal injury of common bile duct is feasible and safe.
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Affiliation(s)
- Yifan Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, 3 East Qingchun Road, Hangzhou, 310016, People's Republic of China
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Son SR, Franco RA, Bae SH, Min YK, Lee BT. Electrospun PLGA/gelatin fibrous tubes for the application of biodegradable intestinal stent in rat model. J Biomed Mater Res B Appl Biomater 2013; 101:1095-105. [DOI: 10.1002/jbm.b.32923] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/10/2013] [Accepted: 02/11/2013] [Indexed: 01/03/2023]
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Liu K, Yu H, Zhang M, Yu Y, Wang Y, Cai X. Sutureless primary repair of colonic perforation with a degradable stent in a porcine model of fecal peritonitis. Int J Colorectal Dis 2012; 27:1607-17. [PMID: 22664946 DOI: 10.1007/s00384-012-1511-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 02/04/2023]
Abstract
PURPOSE 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.
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Affiliation(s)
- Kun Liu
- Department of Hepatobiliary Surgery, Qingdao Municipal Hospital, Ocean University of China, Qingdao, China
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Liang YL, Yu YC, Liu K, Wang WJ, Ying JB, Wang YF, Cai XJ. Repair of bile duct defect with degradable stent and autologous tissue in a porcine model. World J Gastroenterol 2012; 18:5205-10. [PMID: 23066314 PMCID: PMC3468852 DOI: 10.3748/wjg.v18.i37.5205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 07/04/2012] [Accepted: 07/18/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To introduce and evaluate a new method to repair bile duct defect with a degradable stent and autologous tissues.
METHODS: Eight Ba-Ma mini-pigs were used in this study. Experimental models with common bile duct (CBD) defect (0.5-1.0 cm segment of CBD resected) were established and then CBD was reconstructed by duct to duct anastomosis with a novel degradable stent made of poly [sebacic acid-co-(1,3-propanediol)-co-(1,2-propanediol)]. In addition, a vascularized greater omentum was placed around the stent and both ends of CBD. Cholangiography via gall bladder was performed for each pig at postoperative months 1 and 3 to rule out stent translocation and bile duct stricture. Complete blood count was examined pre- and post-operatively to estimate the inflammatory reaction. Liver enzymes and serum bilirubin were examined pre- and post-operatively to evaluate the liver function. Five pigs were sacrificed at month 3 to evaluate the healing of anastomosis. The other three pigs were raised for one year for long-term observation.
RESULTS: All the animals underwent surgery successfully. There was no intraoperative mortality and no bile leakage during the observation period. The white blood cell counts were only slightly increased on day 14 and month 3 postoperatively compared with that before operation, the difference was not statistically significant (P = 0.652). The plasma level of alanine aminotransferase on day 14 and month 3 postoperatively was also not significantly elevated compared with that before operation (P = 0.810). Nevertheless, the plasma level of γ-glutamyl transferase was increased after operation in both groups (P = 0.004), especially 2 wk after operation. The level of serum total bilirubin after operation was not significantly elevated compared with that before operation (P = 0.227), so did the serum direct bilirubin (P = 0.759). By cholangiography via gall bladder, we found that the stent maintained its integrity of shape and was still in situ at month 1, and it disappeared completely at month 3. No severe CBD dilation and stricture were observed at both months 1 and 3. No pig died during the 3-mo postoperative observation period. No sign of necrosis, bile duct stricture, bile leakage or abdominal abscess was found at reoperation at month 3 postoperatively. Pigs had neither fragments of stent nor stones formed in the CBD. Collagen deposit was observed in the anastomosis by hematoxylin and eosin (HE) and Masson’s trichrome stains. No severe cholestasis was observed in liver parenchyma by HE staining. Intestinal obstruction was found in a pig 4 mo after operation, and no bile leakage, bile duct stricture or biliary obstruction were observed in laparotomy. No sign of bile duct stricture or bile leakage was observed in the other two pigs.
CONCLUSION: The novel method for repairing bile duct defect yielded a good short-term effect without postoperative bile duct stricture. However, the long-term effect should be further studied.
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Wang Y, Cai X, Jin R, Liang Y, Huang D, Peng S. Experimental study of primary repair of colonic leakage with a degradable stent in a porcine model. J Gastrointest Surg 2011; 15:1995-2000. [PMID: 21706291 DOI: 10.1007/s11605-011-1593-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 06/10/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anastomotic leakage is a major complication of colon resection. Fecal diversion is necessary in most patients and restoration of intestinal continuity has to be performed several months later. It carries a long treatment time and a considerable financial cost. We have developed a method of primary repair of colonic leakage with a degradable stent. METHODS Thirty pigs were included in this study. Colonic anastomotic leakage model was made successfully by open procedure in 15 pigs and primary repair with a degradable stent was performed 3 days later. Conventional colonic anastomosis was performed in the other 15 pigs without making leakage. Pigs of each group were sacrificed at schedule to evaluate the healing of anastomosis and observe the occurrence of complications. RESULTS No re-leakage occurred after primary repair, and no anastomotic stricture, peritoneal abscess, or colonic necrosis occurred in either group. No significant difference in bursting pressure or hydroxyproline content was found between the two groups. CONCLUSIONS Primary repair of colonic leakage with a degradable stent is a feasible method in this porcine model.
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Affiliation(s)
- Yifan Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, No.3, East Qinchun Road, Hangzhou, 310016, China
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Sutureless Intestinal Anastomosis with a Novel Device of Magnetic Compression Anastomosis. ACTA ACUST UNITED AC 2011; 26:182-9. [DOI: 10.1016/s1001-9294(11)60046-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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