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The effect of sealing with a fixed combination of collagen matrix-bound coagulation factors on the healing of colonic anastomoses in experimental high-risk mice models

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Abstract

Purpose

Experimental and clinical studies on the sealing of colorectal anastomoses in order to reduce the rate of leakage have previously been performed with divergent results. However, comparatively few studies have been performed on anastomotic healing using a fibrin glue-coated patch. The aim of this experimental basic scientific study in mice was to investigate the effect of fibrin glue-coated collagen patches on the healing process of colonic anastomoses in situations of adverse healing process (technical deficiency and peritonitis).

Methods

Colonic anastomoses were carried out in 206 mice and randomized into six groups (I: complete anastomoses, II: sealed complete anastomoses, III: incomplete anastomoses, IV: sealed incomplete anastomoses, V: complete anastomoses in the presence of bacterial peritonitis, VI: sealed complete anastomoses in the presence of bacterial peritonitis). Tissues from the anastomoses were removed and used for functional, histochemical, molecular, and biochemical investigations.

Results

The evaluation of postoperative course data revealed the beneficial effect of additional sealing with a fixed combination of collagen matrix-bound coagulation factors I and IIa (Tachosil®, Nycomed Austria, Linz) in high-risk experimental anastomotic healing. Sealing incomplete anastomoses resulted in significantly lower lethality and leakage rates, as well as significantly higher bursting pressure values and histopathologic scores. Collagen 1 and 3 expressions and hydroxyproline concentrations are greatly increased with additional sealing in all high-risk anastomoses.

Conclusions

In our current model, we demonstrate that additionally sealing high-risk experimental colonic anastomoses provides a positive effect on the healing process. The effect on the molecular level in particular seems to be essential and requires further experimental studies to evaluate the mechanism.

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Abbreviations

ABP:

anastomotic bursting pressure

AHS:

anastomotic healing score

AL:

anastomotic leakage

cDNA:

complimentary DNA

CLP:

cecal ligation puncture

CMBCF:

collagen matrix-bound coagulation factors (Tachosil®)

Col-1:

collagen I

Col-3:

collagen III

HE:

hematoxylin–eosin

HPC:

hydroxyproline concentration

KRB:

Krebs–Ringer buffer

POD:

postoperative day

RT-PCR:

reverse transcriptase-polymerase chain reaction

WT:

wild type

8′-Ana:

complete anastomosis (eight interrupted sutures)

sl_8′Ana:

sealed complete anastomoses

4′-Ana:

incomplete anastomosis (four interrupted sutures)

sl_4′-Ana:

sealed incomplete anastomoses

p-Ana:

peritonitis/sepsis—anastomoses

sl_p-Ana:

peritonitis/sepsis—sealed anastomoses

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Conflicts of interest

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Authors and Affiliations

  1. Department of Surgery, Division of Transplant and Hepatobiliary Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    Dimitrios Pantelis, Anke Beissel, Sven Wehner, Tim O. Vilz & Joerg C. Kalff

  2. Institute of Pathology, University of Bonn, Bonn, Germany

    Philip Kahl

Authors
  1. Dimitrios Pantelis
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  2. Anke Beissel
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  3. Philip Kahl
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  4. Sven Wehner
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  5. Tim O. Vilz
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  6. Joerg C. Kalff
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Corresponding author

Correspondence to Joerg C. Kalff.

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Authors’ contributions

Study conception and design acquisition of data, analysis, and interpretation of data and drafting of manuscript were done by Dimitrios Pantelis. Acquisition of data was made by Anke Beissel and Tim O. Vilz. Acquisition of data analysis and interpretation of data were made by Philip Kahl and Sven Wehner. Jörg C. Kalff made the study conception and design analysis and interpretation of data, as well as the critical revision of the manuscript.

This study was supported by an unrestricted grant from Nycomed Germany which had no influence on the design, execution, or interpretation of the study.

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Pantelis, D., Beissel, A., Kahl, P. et al. The effect of sealing with a fixed combination of collagen matrix-bound coagulation factors on the healing of colonic anastomoses in experimental high-risk mice models. Langenbecks Arch Surg 395, 1039–1048 (2010). https://doi.org/10.1007/s00423-010-0703-5

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  • DOI: https://doi.org/10.1007/s00423-010-0703-5

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