Development and in vivo Assessment of a Rapidly Collapsible Anastomotic Guide for Use in Anastomosis of the Small Intestine: A Pilot Study Using a Swine Model.

Alisha P Pedersen,Rabab N Hamzah,Robert L Donnell,Christopher Griffin,Rebecca E Rifkin,Pierre-Yves Mulon,Zeid A Nima,Karrer M Alghazali,Anwer Mhannawee,David E Anderson,Megan Mccracken,Alexandru S Biris

doi:10.3389/fsurg.2020.587951

Abstract

Various conditions in human and veterinary medicine require intestinal resection and anastomosis, and complications from these procedures are frequent. A rapidly collapsible anastomotic guide was developed for small intestinal end-to-end anastomosis and was investigated in order to assess its utility to improve the anastomotic process and to potentially reduce complication rates. A complex manufacturing method for building a polymeric device was established utilizing biocompatible and biodegradable polyvinylpyrrolidone and polyurethane. This combination of polymers would result in rapid collapse of the material. The guide was designed as a hollow cylinder composed of overlaying shingles that separate following exposure to moisture. An in vivo study was performed using commercial pigs, with each pig receiving one standard handsewn anastomosis and one guide-facilitated anastomosis. Pigs were sacrificed after 13 days, at which time burst pressure, maximum luminal diameter, and presence of adhesions were assessed. Burst pressures were not statistically different between treatment groups, but in vivo anastomoses performed with the guide withstood 10% greater luminal burst pressure and maintained 17% larger luminal diameter than those performed using the standard handsewn technique alone. Surgeons commented that the addition of a guide eased the performance of the anastomosis. Hence, a rapidly collapsible anastomotic guide may be beneficial to the performance of intestinal anastomosis.

Highlights

Small intestinal anastomosis is a relatively common procedure that may be performed in either emergency or elective situations and commonly involves resection of a diseased or damaged segment of the bowel [1,2,3,4,5]
A standard handsewn End-to-end anastomosis (EEA) in one pig was noted to have had minor dehiscence, and no leakage or dehiscence was noted in any of the EEA performed with the anastomotic guide (AG)
During post-mortem assessment, anastomotic site diameter was deemed to be improved in the sites in which an AG was used

Summary

Introduction

Small intestinal anastomosis is a relatively common procedure that may be performed in either emergency or elective situations and commonly involves resection of a diseased or damaged segment of the bowel [1,2,3,4,5]. Regardless of the techniques used, practices that provide the best post-operative recovery include adequate accessibility of the affected bowel segment, gentle manipulation of the bowel and surrounding abdominal structures, appropriate hemostasis and maintenance of vascularization following transection, avoidance of tension at the anastomotic site, proper surgical technique, and prevention of contamination of the abdomen with intestinal contents [2]. A complication that may present itself early in the recovery period is leakage from the anastomotic site. Leakage that occurs within the first day or two after surgery is often associated with the techniques utilized to perform the anastomosis. If leakage occurs beyond the first 5–7 days in the postoperative recovery period, it is more likely to be associated with poor intestinal healing [2]. Peritonitis has a high morbidity and mortality rate and requires additional

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