Small Intestine Submucosa: Intrinsic and Anastomotic Tensile Strength of SIS Using Laser Welding, Fibrin Glue, -Vascular Closure Staples, Endo-GlA Staples and Sutures

Abstract

Small intestinal submucosa (SIS) has been used for the reconstruction of urinary-tract segments. Its utility as a graft material for bladder reconstruction has been somewhat limited by the 7 cm circumference of the porcine small intestine. Accordingly, we studied several anastomotic techniques using an in vitro model. Tensometry data were collected for: dehydrated SIS (2 cm × 1 cm); SIS hydrated for 5, 10, 15, 60, 120 and 180 min; and SIS anastomosed to self and to porcine bladder using: (a) 4–0 Vicryl sutures, (b) KTP laser welding with 50% albumin solder, (c) fibrin glue, (d) vascular closure clips (VCS), or (e) endo-GIA vascular staples. Tensometry for porcine bladder, dehydrated SIS and SIS hydrated for 5, 10, 15 and 60 min was similar (5.0–6.7 N). SIS hydrated for 120 and 180 min had significantly higher breaking strengths (10.9 and 13.2 N, respectively; p < 0.05). Suturing and endo-GIA stapling of SIS to self and bladder produced anastomoses equivalent to the strength of intact SIS. The KTP laser, fibrin glue and VCS produced weak anastomoses, all < 1.0 N. Hydration of SIS for 2 h nearly doubles the tensile strength of the material. Suturing and endo-GIA stapling of strips of SIS produces an anastomosis equivalent in strength to native SIS.