Tovah Z Moss, MD1, Nathan Gasek2, Weiss Dan1, Patrick Forgione, MD1. 1UVM, 2University of Connecticut
Introduction: Leakage of gastric/intestinal contents from disrupted gastrointestinal staple or suture lines is a significant cause of morbidity and mortality for surgical patients undergoing many gastrointestinal surgeries. For example, the incidence of gastric leak after sleeve gastrectomy from staple line disruption is approximately 2.2% and thus affects 2,329 patients annually (Parikh et al., 2013). We have developed multiple materials that show promising qualities for use as GI sealants. These materials are biological polymers that can be tailored and functionalized to harness qualities such as tissue-adhesiveness and increased tensile strength. This pilot study aimed to systematically assess one promising compound, methacrylated gelatin (GELMA) in ex vivo rat stomach models.
Methods and Procedures: Rat stomachs were harvested, the esophagus was cannulated using 18-gauge cannulas and sealed with 0 silk or Ethilon suture. The stomachs were then lavaged to remove excess stomach contents before stapling across the body of the stomach, excluding the pylorus, with vascular staple loads (Medtronic Endo GIA Gray Articulating Reload 30mm Extra Thin/Vascular). The stomach was then tested using our burst pressure device until an air leak was detected. The max pressure was then recorded. 25% (w/v) GELMA sealant (200uL) was then applied to the previously-tested bare staple line (for paired analysis) and re-tested for burst pressure once again. These results were then compared to an equal number (n=5) of rat stomachs that were stapled with buttressed staple loads (Medtronic Endo GIA Reinfored Medium/Thick staple loads).
Results: The mean burst pressure was higher in the GELMA 25% group compared to the bare staple lines, despite these stomachs being tested a second time (202.251 cmH2O vs 483.306 cmH2O, p=0.134). The GELMA-enforced staples had significantly higher mean burst pressures than the commercially-available buttressed staple group (483.306 cmH2O vs 165.844 cmH2O, p=0.036).
Conclusions: These are encouraging preliminary results in evaluating this novel material for use as a gastric staple line reinforcement in bariatric surgery. These results show that GELMA may provide a safe, effective, and practical tool as a gastrointestinal sealant and staple/suture line reinforcement.
Resources: PARIKH, M., ISSA, R., MCCRILLIS, A., SAUNDERS, J.K., UDE-WELCOME, A. & GAGNER, M. 2013. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9991 cases. Ann Surg, 257, 231-7.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94335
Program Number: P177
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster