Abstract
Anastomotic leakage is a frequent complication of intestinal surgery and a major source of surgical morbidity. The timing of anastomotic failures suggests that leaks are the result of inadequate mechanical support during the vulnerable phase of wound healing. To identify a biomaterial with physical and mechanical properties appropriate for assisted anastomotic healing, we studied the adhesive properties of the plant-derived structural heteropolysaccharide called pectin. Specifically, we examined high methoxyl citrus pectin films at water contents between 17–24% for their adhesivity to ex vivo porcine small bowel serosa. In assays of tensile adhesion strength, pectin demonstrated significantly greater adhesivity to the serosa than either nanocellulose fiber (NCF) films or pressure sensitive adhesives (PSA) (p < 0.001). Similarly, in assays of shear resistance, pectin demonstrated significantly greater adhesivity to the serosa than either NCF films or PSA (p < 0.001). Finally, the pectin films were capable of effectively sealing linear enterotomies in a bowel simulacrum as well as an ex vivo bowel segment. We conclude that pectin is a biomaterial with physical and adhesive properties capable of facilitating anastomotic healing after intestinal surgery.
Highlights
Cancer is the most common indication for gastrointestinal surgery
The current trend is toward multimodal therapeutic approaches including chemotherapy, biologic therapies, and radiotherapy [4,5], surgery remains the mainstay of contemporary treatment
We have previously shown that high methoxyl pectin adheres to the surface of visceral organs including bowel lung heart and liver [28]
Summary
Cancer is the most common indication for gastrointestinal surgery. In 2021, an estimated 3 million people world-wide will have a new diagnosis of gastric or colorectal cancer [1,2,3]. The current trend is toward multimodal therapeutic approaches including chemotherapy, biologic therapies, and radiotherapy [4,5], surgery remains the mainstay of contemporary treatment. The surgical resection of the tumor-bearing portion of the gastrointestinal tract provides important staging information as well as therapeutic value in the treatment of most gastrointestinal cancers. Surgical resection of the tumor, requires the anastomosis of the two remaining ends of the bowel. This problem has been addressed with many different hand-sewn and stapled techniques of bowel anastomosis. Over the past 100 years [6,7,8], the techniques have varied widely including differences in suture material (absorbable versus non-absorbable), suture placement, single- versus double-layers and continuous versus interrupted sutures [8]. Despite the variability in the anastomotic details, a consistent feature of both hand-sewn and stapled techniques is the universal objective to achieve reinforced serosal apposition [7]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
