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.
Share and Cite:
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.