Journal of Gastrointestinal Surgery

, Volume 11, Issue 7, pp 918–922 | Cite as

Small Intestinal Submucosa (SIS) in the Repair of a Cecal Wound in Unprepared Bowel in Rats

  • Tomio Ueno
  • Atsunori Oga
  • Toku Takahashi
  • Theodore N. Pappas



Porcine-derived small intestinal submucosa (SIS) has been accepted as an acellular matrix for tissue regeneration. However, its use for remodeling gastrointestinal defects has been poorly investigated. Our previous study of the rodent stomach has demonstrated that the SIS stimulates regeneration of native tissue under acidic conditions. The purpose of this paper was to investigate the feasibility of using SIS as a bioscaffold for a colonic defect in unprepared bowel.


A 1 × 1-cm whole layer was excised on the anterior wall of the cecum in 24 rats, followed by onlay repair with SIS. Measurement outcomes included animal survival, mesh stability in situ, and histologic evaluation at 3 weeks and 6 months.


Rats showed a significant weight gain and had no evidence of postoperative leakage. All wounds were secured and associated with either omental or other fatty adhesions. Histological findings revealed that intact mucosa covered the area of the graft in all cases 6 months after surgery and that the defect was completely replaced by the normal constituents (mucosa, muscle, and nerve cells) of the bowel wall.


SIS was largely successful in promoting healing in a cecal wound in unprepared bowel and serving as a bioscaffold for regeneration of the native colonic tissue. Small intestinal submucosa may be useful in surgical anastomoses to promote healing and presumably prevent leakage.


Small intestinal submucosa (SIS) Acellular matrix Cecum defect repair 



The authors are indebted to Gerald Olson, D.V.M., M.S., and Rick Leary, R.V.T., for their skilled technical assistance in Durham VA animal facility and Omar I. Abdel-Wahab, M.D., in Massachusetts General Hospital for his help in preparing the manuscript. The Cook Company (makers of SIS) supported this work by contributing SIS for use in this study.


  1. 1.
    Badylak S, Meurling S, Chen M, Spievack A, Simmons-Byrd A. Resorbable bioscaffold for esophageal repair in a dog model. J Pediatr Surg 2000;35:1097–1103.PubMedCrossRefGoogle Scholar
  2. 2.
    Chen MK, Badylak SF. Small bowel tissue engineering using small intestinal submucosa as a scaffold. J Surg Res 2001;99:352–358.PubMedCrossRefGoogle Scholar
  3. 3.
    Rosen M, Ponsky J, Petras R, Fanning A, Brody F, Duperier F. Small intestinal submucosa as a bioscaffold for biliary tract regeneration. Surgery 2002;132:480–486.PubMedCrossRefGoogle Scholar
  4. 4.
    de la Fuente SG, Gottfried MR, Lawson DC, Harris MB, Mantyh CR, Pappas TN. Evaluation of porcine-derived small intestine submucosa as a biodegradable graft for gastrointestinal healing. J Gastrointest Surg 2003;7:96–101.PubMedCrossRefGoogle Scholar
  5. 5.
    Badylak SF. The extracellular matrix as a scaffold for tissue reconstruction. Semin Cell Dev Biol 2002;13:377–383.PubMedCrossRefGoogle Scholar
  6. 6.
    Brown-Etris M, Cutshall WD, Hiles MC. A new biomaterial derived from small intestine submucosa and developed into a wound matrix device. Wounds 2002;14:150–166.Google Scholar
  7. 7.
    Pope JCt, Davis MM, Smith ER, Jr., et al. The ontogeny of canine small intestinal submucosa regenerated bladder. J Urol 1997;158:1105–1110.PubMedCrossRefGoogle Scholar
  8. 8.
    Badylak SF, Tullius R, Kokini K, et al. The use of xenogeneic small intestinal submucosa as a biomaterial for Achilles tendon repair in a dog model. J Biomed Mater Res 1995;29:977–985.PubMedCrossRefGoogle Scholar
  9. 9.
    Prevel CD, Eppley BL, Summerlin DJ, Jackson JR, McCarty M, Badylak SF. Small intestinal submucosa: utilization for repair of rodent abdominal wall defects. Ann Plast Surg 1995;35:374–380.PubMedCrossRefGoogle Scholar
  10. 10.
    Clarke KM, Lantz GC, Salisbury SK, Badylak SF, Hiles MC, Voytik SL. Intestine submucosa and polypropylene mesh for abdominal wall repair in dogs. J Surg Res 1996;60:107–114.PubMedCrossRefGoogle Scholar
  11. 11.
    Dalla Vecchia L, Engum S, Kogon B, Jensen E, Davis M, Grosfeld J. Evaluation of small intestine submucosa and acellular dermis as diaphragmatic prostheses. J Pediatr Surg 1999;34:167–171.PubMedCrossRefGoogle Scholar
  12. 12.
    Sandusky GE, Lantz GC, Badylak SF. Healing comparison of small intestine submucosa and ePTFE grafts in the canine carotid artery. J Surg Res 1995;58:415–420.PubMedCrossRefGoogle Scholar
  13. 13.
    Voytik-Harbin SL, Brightman AO, Kraine MR, Waisner B, Badylak SF. Identification of extractable growth factors from small intestinal submucosa. J Cell Biochem 1997;67:478–491.PubMedCrossRefGoogle Scholar
  14. 14.
    Voytik-Harbin SL, Brightman AO, Waisner BZ, Robinson JP, Lamar CH. Small intestinal submucosa: a tissue-derived extracellular matrix that promotes tissue-specific growth and differentiation of cells in vitro. Tissue Eng 1998;4:157–173.CrossRefGoogle Scholar
  15. 15.
    Hodde JP, Record RD, Liang HA, Badylak SF. Vascular endothelial growth factor in porcine-derived extracellular matrix. Endothelium 2001;8:11–24.PubMedGoogle Scholar
  16. 16.
    Hurst RE, Bonner RB. Mapping of the distribution of significant proteins and proteoglycans in small intestinal submucosa by fluorescence microscopy. J Biomater Sci Polym Ed 2001;12:1267–1279.PubMedCrossRefGoogle Scholar
  17. 17.
    Hodde JP, Hiles MC. Bioactive FGF-2 in sterilized extracellular matrix. Wounds 2001;13:195–201.Google Scholar
  18. 18.
    Badylak SF, Kropp B, McPherson T, Liang H, Snyder PW. Small intestinal submucosa: a rapidly resorbed bioscaffold for augmentation cystoplasty in a dog model. Tissue Eng 1998;4:379–387.PubMedCrossRefGoogle Scholar
  19. 19.
    Hiles MC, Badylak SF, Lantz GC, Kokini K, Geddes LA, Morff RJ. Mechanical properties of xenogeneic small-intestinal submucosa when used as an aortic graft in the dog. J Biomed Mater Res 1995;29:883–891.PubMedCrossRefGoogle Scholar
  20. 20.
    Record RD, Hillegonds D, Simmons C, et al. In vivo degradation of 14C-labeled small intestinal submucosa (SIS) when used for urinary bladder repair. Biomaterials 2001;22:2653–2659.PubMedCrossRefGoogle Scholar
  21. 21.
    Ueno T, Pickett LC, de la Fuente SG, Lawson DC, Pappas TN. Clinical application of porcine small intestinal submucosa in the management of infected or potentially contaminated abdominal defects. J Gastrointest Surg 2004;8:109–112.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Tomio Ueno
    • 1
    • 2
  • Atsunori Oga
    • 3
  • Toku Takahashi
    • 2
  • Theodore N. Pappas
    • 2
  1. 1.Department of Surgery IIYamaguchi University Graduate School of MedicineUbeJapan
  2. 2.Department of SurgeryDuke University Medical CenterDurhamUSA
  3. 3.Department of Pathology IIYamaguchi University Graduate School of MedicineUbeJapan

Personalised recommendations