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Chen X, Gong Y, Li M, Zeng Q, Xu R, Li X, Lu X, Gong S, Xu J, Li G, Yang J, Jiao W, Liu J, Liu Y, Liang X, He L, Xiao F, Chen W. An Interior/Exterior Collaboration-Enhanced Intestinal Anastomosis (IECIA) for Multi-Tiered Leakage Complication Management. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2025; 21:e2408222. [PMID: 39690800 DOI: 10.1002/smll.202408222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/26/2024] [Indexed: 12/19/2024]
Abstract
Anastomotic leakage (AL) is a pervasive and risky postoperative complication that presently features inaccessible prevention, delayed diagnosis, and intractable remediation, resulting in distressing morbidity and mortality. Herein an interior/exterior collaboration-enhanced neoteric intestinal anastomosis (IECIA) is developed, which consists of an interior hydrogel-based protective barrier adhering to mucosa, and exterior synergistic leakage-prevention safeguard sutured to serosa, for multi-tiered leakage complication management. Noticeably, the hydrogel barrier protects anastomosis stoma against injurious stimulation from digestive liquid, consequently reducing leakage risk effectively and comfortably in place of painful gastric tube insertion. The exterior safeguard encompassing fluorescein-loaded hydrogel and electrospun film functions as a secondary defense, exhibiting critical leakage-prevention capability to refrain from lethal intra-abdominal infection. Meanwhile, fluorescein is released to the enteric cavity for following detection within the excrement in case anastomotic leakage occurs, achieving presymptomatic alarming in providing valuable prompts for timely clinical intervention. Importantly, IECIA has been investigated in realistic in vivo end-to-end intestinal anastomosis scenarios as well as simulated leakage models, which present satisfactory postoperative recovery of gastrointestinal functions and systematic indexes. Moreover, the IECIA system is endowed with guaranteed biocompatibility, effective durability, comprehensibility for surgical operation, comfort, and compliance for patients, which demonstrates precious value for clinical translation.
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Affiliation(s)
- Xiuli Chen
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yusheng Gong
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min Li
- Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Qi Zeng
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Rengui Xu
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Research Center for Tissue Engineering and Regenerative Medicine, Union Hospital, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaolong Li
- Key Laboratory of Material Chemistry for Energy Conversion and Storage of Ministry of Education, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Xiang Lu
- Key Laboratory of Material Chemistry for Energy Conversion and Storage of Ministry of Education, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Shang Gong
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore
| | - Jiarong Xu
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Guanyue Li
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jingwen Yang
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wenhao Jiao
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jiajing Liu
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuan Liu
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xinting Liang
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Linxi He
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Fei Xiao
- Key Laboratory of Material Chemistry for Energy Conversion and Storage, Ministry of Education, Hubei Key Laboratory of Material Chemistry and Service Failure, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Wei Chen
- Department of Pharmacology, School of Basic Medicine, State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Tongji-Rongcheng Center for Biomedicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- Hubei Key Laboratory of Drug Target Research and Pharmacodynamic Evaluation Huazhong University of Science and Technology, Wuhan, 430030, China
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de Moura DTH, de Moura BFBH, Manfredi MA, Hathorn KE, Bazarbashi AN, Ribeiro IB, de Moura EGH, Thompson CC. Role of endoscopic vacuum therapy in the management of gastrointestinal transmural defects. World J Gastrointest Endosc 2019; 11:329-344. [PMID: 31205594 PMCID: PMC6556487 DOI: 10.4253/wjge.v11.i5.329] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/16/2019] [Accepted: 05/01/2019] [Indexed: 02/06/2023] Open
Abstract
A gastrointestinal (GI) transmural defect is defined as total rupture of the GI wall, and these defects can be divided into three categories: perforations, leaks, and fistulas. Surgical management of these defects is usually challenging and may be associated with high morbidity and mortality rates. Recently, several novel endoscopic techniques have been developed, and endoscopy has become a first-line approach for therapy of these conditions. The use of endoscopic vacuum therapy (EVT) is increasing with favorable results. This technique involves endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. This promotes healing via five mechanisms, including macrodeformation, microdeformation, changes in perfusion, exudate control, and bacterial clearance, which is similar to the mechanisms in which skin wounds are treated with commonly employed wound vacuums. EVT can be used in the upper GI tract, small bowel, biliopancreatic regions, and lower GI tract, with variable success rates and a satisfactory safety profile. In this article, we review and discuss the mechanism of action, materials, techniques, efficacy, and safety of EVT in the management of patients with GI transmural defects.
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Affiliation(s)
- Diogo Turiani Hourneaux de Moura
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
- Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
| | | | - Michael A Manfredi
- Esophageal and Airway Atresia Treatment Center, Boston Children's Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Kelly E Hathorn
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Ahmad N Bazarbashi
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
| | - Igor Braga Ribeiro
- Department of Endoscopy of Clinics Hospital of São Paulo University, São Paulo 05403-000, Brazil
| | | | - Christopher C Thompson
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital - Harvard Medical School, Boston, MA 02115, United States
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