SS  Vol.6 No.2 , February 2015
Intestinal Staple Line Reinforcement Using MatriStem
Abstract: Background: Staple line reinforcement material has been demonstrated to raise the burst pressure threshold after linear intestinal stapling. Numerous bioprosthetic materials have been utilized in surgical practice. Porcine urinary bladder matrix (ACell, Inc.) is an extracellular matrix material derived from porcine bladder used to reinforce surgically repaired soft tissue, and facilitate the body’s regenerative capacity. Objective: This study represents the first evaluation of urinary bladder matrix in gastrointestinal staple line reinforcement. Methods: Pathogen-free pigs underwent midline laparotomy under general anesthesia. Small intestinal division was performed with an endoscopic linear stapler. Nineteen intestinal divisions were performed with urinary bladder matrix staple line reinforcement, and twenty divisions were unreinforced. Staple lines were then subjected to burst pressure analysis by intraluminal infusion of dyed Krebs solution at an infusion rate of 20 ml·min-1 under manometric monitoring. Upon visible staple line extravasation, intraluminal pressure was recorded. Results: Intestinal staple lines reinforced with urinary bladder matrix exhibited significantly higher burst pressure threshold (p < 0.05). Reinforced staple lines had an average burst pressure of 99 ± 33 mmHg, compared to 61 ± 37 mmHg for unreinforced staple lines. Conclusion: Staple line reinforcement using urinary bladder matrix acutely improves burst pressures of intestinal staple lines when compared with unreinforced staple lines. Its regenerative properties may confer a long-term advantage to staple line reinforcement. These findings, along with previous findings of constructive remodeling in the presence of urinary bladder matrix in treatment of the gastrointestinal system, suggest that UBM may serve a role in gastrointestinal staple line reinforcement.
Cite this paper: Sasse, K. , Warner, D. , Ward, S. , Mandeville, W. and Evans, R. (2015) Intestinal Staple Line Reinforcement Using MatriStem. Surgical Science, 6, 65-70. doi: 10.4236/ss.2015.62011.

[1]   Podnos, Y.D., Jimenez, J.C., Wilson, S.E., Stevens, C.M. and Nguyen, N.T. (2003) Complications after Laparoscopic Gastric Bypass: A Review of 3464 Cases. Archives of Surgery, 138, 957-961.

[2]   Vignali, A., Fazio, V.W., Lavery, I.C., et al. (1997) Factors Associated with the Occurrence of Leaks in Stapled Rectal Anastomoses: A Review of 1014 Patients. Journal of the American College of Surgeons, 185, 105-113.

[3]   Baker, R.S., Foote, J., Kemmeter, P., Brady, R., Vroegop, T. and Serveld, M. (2004) The Science of Stapling Leaks. Obesity Surgery, 14, 1290-1298.

[4]   Downey, D.M., Harre, J.G. and Dolan, J.P. (2005) Increased Burst Pressure in Gastrointestinal Staple-Lines Using Reinforcement with a Bioprosthetic Material. Obesity Surgery, 15, 1379-1383.

[5]   Arnold, W. and Shikora, S.A. (2005) A Comparison of Burst Pressure between Buttressed Versus Non-Buttressed Staple-Lines in an Animal Model. Obesity Surgery, 14, 164-171.

[6]   Assalia, A., Ueda, K., Matteotti, R., Cuenca-Abente, F., Rogula, T. and Gagner, M. (2007) Staple-Line Reinforcement with Bovine Pericardium in Laparoscopic Sleeve Gastrectomy: Experimental Comparative Study in Pigs. Obesity Surgery, 17, 222-228.

[7]   Hope, W.W., Zerey, M., Schmelzer, T.M., et al. (2009) A Comparison of Gastrojejunal Anastomoses with or without Buttressing in a Porcine Model. Surgical Endoscopy, 23, 800-807.

[8]   Shikora, S.A. (2004) The Use of Staple-Line Reinforcement during Laparoscopic Gastric Bypass. Obesity Surgery, 14, 1313-1320.

[9]   Ballantyne, G.H., Burke, J.B., Rogers, G., Rogers, G., Lampert, E.G. and Boccia, J. (1985) Accelerated Wound Healing with Stapled Enteric Suture Lines. Annals of Surgery, 201, 360-364.

[10]   Consten, E.C.J., Gagner, M., Pomp, A. and Inabnet, W.B. (2004) Decreased Bleeding after Laparoscopic Sleeve Gastrectomy with or without Duodenal Switch for Morbid Obesity Using a Stapled Buttressed Absorbable Polymer Membrane. Obesity Surgery, 14, 1360-1366.

[11]   Yo, L.S.F., Consten, E.C.J., Quarles van Ufford, H.M.E., Gooszen, H.G. and Gagner, M. (2006) Buttressing of the Staple Line in Gastrointestinal Anastomoses: Overview of New Technology Designed to Reduce Perioperative Complications. Digestive Surgery, 23, 283-291.

[12]   Brown, B., Lindberg, K., Reing, J., Stolz, D.B. and Badylak, S.F. (2006) The Basement Membrane Component of Biologic Scaffolds Derived from Extracellular Matrix. Tissue Engineering, 12, 519-526.

[13]   Brennan, E.P., Reing, J., Chew, D., Myers-Irvin, J.M., Young, E.J. and Badylak, S.F. (2006) Antibacterial Activity within Degradation Products of Biological Scaffolds Composed of Extracellular Matrix. Tissue Engineering, 12, 2949-2955.

[14]   Brown, B., Lindberg, K., Reing, J., Stolz, D.B. and Badylak, S.F. (2006) The Basement Membrane Component of Biologic Scaffolds Derived from Extracellular Matrix. Tissue Engineering, 12, 519-526.

[15]   Agrawal, V., Johnson, S.A., Reing, J., Zhang, L., Tottey, S., Wang, G., et al. (2010) Epimorphic Regeneration Approach to Tissue Replacement in Adult Mammals. Proceedings of the National Academy of Sciences of the United States of America, 107, 3351-3355.

[16]   Gilbert, T.W., Nieponice, A., Spievack, A.R., Holcomb, C.J., Gilbert, S. and Badylak, S.F. (2007) Repair of the Thoracic Wall with an Extracellular Matrix Scaffold in a Canine Model. Journal of Surgical Research, 147, 61-67.

[17]   Badylak, S.F., Vorp, D.A., Spievack, A.R., Simmons-Byrd, A., Hanke, J., Freytes, D.O., et al. (2005) Esophageal Reconstruction with ECM and Muscle Tissue in a Dog Model. Journal of Surgical Research, 128, 87-97.

[18]   Nieponice, A., Ciotola, F.F., Nachman, F., Jobe, B.A., Hoppo, T., Londono, R., Badylak, S. and Badalone, A.E. (2014) Patch Esophagoplasty: Esophageal Reconstruction Using Biological Scaffolds. The Annals of Thoracic Surgery, 97, 283-288.