Kern Nora G, Behrens Adam M, Srinivasan Priya, Rossi Christopher T, Daristotle John L, Kofinas Peter, Sandler Anthony D
Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System, 111 Michigan Ave. NW, Washington, DC 20010, USA; Department of Urology, University of Virginia Health System, PO Box 800422, Charlottesville, VA 22908, USA.
Fischell Department of Bioengineering, University of Maryland, 8228 Paint Branch Dr., College Park, MD 20742, USA.
J Pediatr Surg. 2017 Aug;52(8):1308-1312. doi: 10.1016/j.jpedsurg.2016.11.044. Epub 2016 Dec 5.
Solution blow spinning is a technique for depositing polymer fibers with promising potential use as a surgical sealant. This study assessed the feasibility and efficacy of solution blow spun polymer (BSP) for sealing bowel perforations in a mouse model of partial cecal transection. We then evaluated its use for reinforcing a surgical anastomosis in a preclinical piglet model.
Three commercially available surgical sealants (fibrin glue, polyethylene glycol (PEG) hydrogel, and cyanoacrylate) were compared to BSP in the ability to seal partially transected cecum in mice. For anastomosis feasibility testing in a piglet model, piglets were subjected to small bowel transection with sutured anastomosis reinforced with BSP application. Outcome measures included anastomotic burst pressure, anastomotic leak rate, 14-day survival, and complication rate.
For the mouse model, the survival rates for the sealants were 30% for fibrin glue, 20% for PEG hydrogel, 78% for cyanoacrylate, and 67% for BSP. Three of 9 mice died after BSP administration because of perforation leak, failure to thrive with partial obstruction at the perforation site, and unknown causes. All other mice died of perforation leak. The mean burst pressure at 24h was significantly higher for BSP (81mm Hg) when compared to fibrin glue (6mm Hg, p=0.047) or PEG hydrogel (10mm Hg, p=0.047), and comparable to cyanoacrylate (64mm Hg, p=0.91). For piglets, 4 of 4 animals survived at 14days. Mean burst pressures at time of surgery were 37±5mm Hg for BSP and 11±9mm Hg for suture-only controls (p=0.09).
Solution blow spinning may be an effective technique as an adjunct for sealing of gastrointestinal anastomosis. Further preclinical testing is warranted to better understand BSP properties and alternative surgical applications.
溶液吹纺是一种用于沉积聚合物纤维的技术，作为手术密封剂具有潜在的应用前景。本研究评估了溶液吹纺聚合物（BSP）在部分盲肠横断小鼠模型中密封肠穿孔的可行性和有效性。然后，我们在临床前仔猪模型中评估了其用于加强手术吻合的效果。
将三种市售手术密封剂（纤维蛋白胶、聚乙二醇（PEG）水凝胶和氰基丙烯酸酯）与BSP在密封小鼠部分横断盲肠的能力方面进行比较。对于仔猪模型中的吻合可行性测试，对仔猪进行小肠横断，并通过应用BSP加强缝合吻合。观察指标包括吻合口破裂压力、吻合口漏率、14天生存率和并发症发生率。
对于小鼠模型，密封剂的生存率分别为：纤维蛋白胶30%，PEG水凝胶20%，氰基丙烯酸酯78%，BSP 67%。9只接受BSP治疗的小鼠中有3只因穿孔渗漏、穿孔部位部分梗阻导致发育不良以及不明原因死亡。所有其他小鼠均死于穿孔渗漏。与纤维蛋白胶（6mmHg，p=0.047）或PEG水凝胶（10mmHg，p=0.047）相比，BSP在24小时时的平均破裂压力显著更高（81mmHg），与氰基丙烯酸酯（64mmHg，p=0.91）相当。对于仔猪，4只动物中有4只在14天时存活。手术时BSP的平均破裂压力为37±5mmHg，仅缝合对照组为11±9mmHg（p=0.09）。
溶液吹纺可能是一种有效的技术，可作为胃肠道吻合密封的辅助手段。有必要进行进一步的临床前测试，以更好地了解BSP的特性和其他手术应用。
