Poly-ε-caprolactone scaffold for the reinforcement of stapled small intestinal anastomoses: a randomized experimental study

  • K. D. Larsen
  • M. Westerholt
  • G. I. Madsen
  • D. Q. S. Le
  • Niels QvistEmail author
  • M. B. Ellebæk
Original Articles



Anastomotic leakage is a severe complication in gastrointestinal surgery. Different methods have been evaluated for anastomotic reinforcement to prevent anastomotic leakage. The aim of this study was to investigate the effect of a poly-ε-caprolactone (PCL) scaffold incorporated in the staple-line, on the anastomotic strength and histological wound healing, of small intestinal anastomoses in piglets.


This randomized experimental trial included 17 piglets. In each piglet, three end-to-end anastomoses were performed in the small intestine with a circular stapler, i.e. one control and two interventional anastomoses. On postoperative day 5, the anastomoses were resected and subjected to tension stretch test and histological examination.


No anastomotic leakage occurred. In the interventional anastomoses, the mean value for maximal tensile strength was 15.7 N, which was significantly higher than control anastomoses 12.7 N (p = 0.01). No statistically significant differences were found between the two groups in the histopathological parameters.


To conclude, this study has shown that the incorporation of a PCL scaffold in the staple-line was feasible and significantly increased the maximal tensile strength of small intestine anastomoses in piglets on postoperative day 5. The difference in histological parameters was not significantly distinct.


Poly-ε-caprolactone Scaffold Intestinal anastomosis Reinforcement Colorectal surgery 



The authors wish to thank veterinarian Louise Langhorn, head of Biomedical Laboratory Peter Bollen, and medical doctors Signe Steenstrup Jensen and Kristina Gosvig for their surgical assistance and support with animal care.

The data, methods used in the analysis and materials used to conduct the research will be made available to any researcher for the purposes of reproducing the results of replicating the procedure and can be accessed at = 0

Authors’ contributions

K.D. Larsen and M. Westerholt conceived and designed the study, collected the data, analysed and interpreted the data, drafted the manuscript and obtained funding. G. Madsen collected the data, provided critical revisions and approved the final version of the manuscript. D.Q.S. Le conceived and designed the study, provided critical revisions and approved the final version of the manuscript. N. Qvist and M.B. Ellebæk conceived and designed the study, provided critical revisions that are important for the intellectual content and approved the final version of the manuscript.

Funding information

Odense University Hospital Research Foundation financed the study (34-A1718).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed.

This article does not contain any studies with human participants performed by any of the authors.


  1. 1.
    Kube R, Mroczkowski P, Granowski D, Benedix F, Sahm M, Schmidt U, Gastinger I, Lippert H, Study group Qualitätssicherung Kolon/Rektum-Karzinome (Primärtumor) (Quality assurance in primary colorectal carcinoma) (2010) Anastomotic leakage after colon cancer surgery: a predictor of significant morbidity and hospital mortality, and diminished tumour-free survival. Eur J Surg Oncol 36(2):120–124CrossRefGoogle Scholar
  2. 2.
    Ha GW, Kim JH, Lee MR (2017) Oncologic impact of anastomotic leakage following colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg Oncol 24(11):3289–3299CrossRefGoogle Scholar
  3. 3.
    Bobkiewicz A, Studniarek A, Krokowicz L, Szmyt K, Borejsza-Wysocki M, Szmeja J, Marciniak R, Drews M, Banasiewicz T (2017) Gastrointestinal tract anastomoses with the biofragmentable anastomosis ring: is it still a valid technique for bowel anastomosis? Analysis of 203 cases and review of the literature. Int J Color Dis 32(1):107–111CrossRefGoogle Scholar
  4. 4.
    Daams F, Luyer M, Lange JF (2013) Colorectal anastomotic leakage: aspects of prevention, detection and treatment. World J Gastroenterol 19(15):2293–2297CrossRefGoogle Scholar
  5. 5.
    Thompson SK, Chang EY, Jobe BA (2006) Clinical review: healing in gastrointestinal anastomoses, part I. Microsurgery 26(3):131–136CrossRefGoogle Scholar
  6. 6.
    Enestvedt CK, Thompson SK, Chang EY, Jobe BA (2006) Clinical review: healing in gastrointestinal anastomoses, part II. Microsurgery 26(3):137–143CrossRefGoogle Scholar
  7. 7.
    Yo LS, Consten EC (2006) Quarles van Ufford HM, Gooszen HG, Gagner M. Buttressing of the staple line in gastrointestinal anastomoses: overview of new technology designed to reduce perioperative complications. Dig Surg 23(5-6):283–291CrossRefGoogle Scholar
  8. 8.
    Nordentoft T. Sealing of gastrointestinal anastomoses with fibrin glue coated collagen patch. Dan Med J. 2015;62(5):piiB5081.Google Scholar
  9. 9.
    Baiguera S, Urbani L, Del Gaudio C (2014) Tissue engineered scaffolds for an effective healing and regeneration: reviewing orthotopic studies. Biomed Res Int 2014:398069CrossRefGoogle Scholar
  10. 10.
    Woodruff MA, Hutmacher DW (2010) The return of a forgotten polymer—polycaprolactone in the 21st century. Prog Polym Sci 35(10):1217–1256CrossRefGoogle Scholar
  11. 11.
    Janvikul W, Uppanan P, Thavornyutikarn B, Kosorn W, Kaewkong P (2013) Effects of surface topography, hydrophilicity and chemistry of surface-treated PCL scaffolds on chondrocyte infiltration and ECM production. Procedia Eng 59:158–165CrossRefGoogle Scholar
  12. 12.
    Ikeuchi D, Onodera H, Aung T, Kan S, Kawamoto K, Imamura M et al (1999) Correlation of tensile strength with bursting pressure in the evaluation of intestinal anastomosis. Dig Surg 16(6):478–485CrossRefGoogle Scholar
  13. 13.
    Verhofstad MH, Lange WP, van der Laak JA, Verhofstad AA, Hendriks T (2001) Microscopic analysis of anastomotic healing in the intestine of normal and diabetic rats. Dis Colon Rectum 44(3):423–431CrossRefGoogle Scholar
  14. 14.
    Fajardo AD, Chun J, Stewart D, Safar B, Fleshman JW (2011) 1.5:1 meshed AlloDerm bolsters for stapled rectal anastomoses does not provide any advantage in anastomotic strength in a porcine model. Surg Innov 18(1):21–28CrossRefGoogle Scholar
  15. 15.
    Hoeppner J, Crnogorac V, Marjanovic G, Juttner E, Keck T, Weiser HF et al (2009) Small intestinal submucosa for reinforcement of colonic anastomosis. Int J Color Dis 24(5):543–550CrossRefGoogle Scholar
  16. 16.
    Downey DM, Harre JG, Dolan JP (2005) Increased burst pressure in gastrointestinal staple-lines using reinforcement with a bioprosthetic material. Obes Surg 15(10):1379–1383CrossRefGoogle Scholar
  17. 17.
    Parker MC, Pohlen U, Borel Rinkes IH, Delvin T (2013) The application of TachoSil(R) for sealing colorectal anastomosis: a feasibility study. Color Dis 15(2):252–257CrossRefGoogle Scholar
  18. 18.
    Suarez-Grau JM, Bernardos Garcia C, Cepeda Franco C, Mendez Garcia C, Garcia Ruiz S, Docobo Durantez F et al (2016) Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats. World J Gastrointest Surg 8(9):627–633CrossRefGoogle Scholar
  19. 19.
    Senagore A, Lane FR, Lee E, Wexner S, Dujovny N, Sklow B, Rider P, Bonello J, Bioabsorbable Staple Line Reinforcement Study Group (2014) Bioabsorbable staple line reinforcement in restorative proctectomy and anterior resection: a randomized study. Dis Colon Rectum 57(3):324–330CrossRefGoogle Scholar
  20. 20.
    Bakker IS, Morks AN, Ten Cate Hoedemaker HO, Burgerhof JGM, Leuvenink HG, van Praagh JB et al (2017) Randomized clinical trial of biodegradable intraluminal sheath to prevent anastomotic leak after stapled colorectal anastomosis. Br J Surg 104(8):1010–1019CrossRefGoogle Scholar
  21. 21.
    Barralet JE, Wallace LL, Strain AJ (2003) Tissue engineering of human biliary epithelial cells on polyglycolic acid/polycaprolactone scaffolds maintains long-term phenotypic stability. Tissue Eng 9(5):1037–1045CrossRefGoogle Scholar
  22. 22.
    Pabittei DR, Heger M, van Tuijl S, Simonet M, de Boon W, van der Wal AC, Balm R, de Mol BA (2015) Ex vivo proof-of-concept of end-to-end scaffold-enhanced laser-assisted vascular anastomosis of porcine arteries. J Vasc Surg 62(1):200–209CrossRefGoogle Scholar
  23. 23.
    Azimi B, Nourpanah P, Rabiee M, Arbab S (2014) Poly (epsilon-caprolactone) Fiber: an overview. J Eng Fiber Fabr 9(3):74–90Google Scholar
  24. 24.
    Diemer P, Markoew S, Le DQ, Qvist N (2015) Poly-epsilon-caprolactone mesh as a scaffold for in vivo tissue engineering in rabbit esophagus. Dis Esophagus 28(3):240–245CrossRefGoogle Scholar
  25. 25.
    Freud E, Efrati I, Kidron D, Finally R, Mares AJ (1999) Comparative experimental study of esophageal wall regeneration after prosthetic replacement. J Biomed Mater Res 45(2):84–91CrossRefGoogle Scholar
  26. 26.
    Demirbilek S, Kanmaz T, Ozardali I, Edali MN, Yucesan S (2003) Using porcine small intestinal submucosa in intestinal regeneration. Pediatr Surg Int 19(8):588–592CrossRefGoogle Scholar
  27. 27.
    Teller P, White TK (2009) The physiology of wound healing: injury through maturation. Surg Clin North Am 89(3):599–610CrossRefGoogle Scholar
  28. 28.
    Bosmans JW, Moossdorff M, Al-Taher M, van Beek L, Derikx JP, Bouvy ND (2016) International consensus statement regarding the use of animal models for research on anastomoses in the lower gastrointestinal tract. Int J Color Dis 31(5):1021–1030CrossRefGoogle Scholar
  29. 29.
    Kjær M (2019) Collagen and biomechanics in early surgical wound healing [Phd]. University of Copenhagen, KøbenhavnGoogle Scholar
  30. 30.
    Oxlund H, Christensen H, Seyer-Hansen M, Andreassen TT (1996) Collagen deposition and mechanical strength of colon anastomoses and skin incisional wounds of rats. J Surg Res 66(1):25–30CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Research Unit for SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
  2. 2.Research Unit for PathologyOdense University Hospital, University of Southern DenmarkOdenseDenmark
  3. 3.Department of Clinical MedicineAarhus UniversityAarhusDenmark
  4. 4.Danish Centre for Regenerative Medicine (CRM)Odense University HospitalOdenseDenmark

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