Wiebe Anna, Hagemeister Kerstin, Fayyazi Afshin, Apitzsch Jonas, Lamadé Wolfram
Department of Vascular Surgery, Klinikum Esslingen, Hirschlandstraße 97, 73730, Esslingen, Germany.
Universitätsklinikum Bonn, Haus für Experimentelle Therapie, Venusberg-Campus, Bonn, Germany.
Surg Endosc. 2025 May 23. doi: 10.1007/s00464-025-11802-5.
Pancreatic anastomosis is a critical step in partial pancreatoduodenectomy, as failure of the anastomosis with postoperative pancreatic fistula can lead to high morbidity and mortality. While various fibrin-based sealing agents have been tested, their effectiveness is limited due to rapid degradation by pancreatic secretions. This study aimed to evaluate the applicability and biocompatibility of a novel biodegradable, polyurethane-based adhesive (VIVO 120™) for intraoperative sealing of pancreatic anastomoses in a long-term survival pig model.
An in vitro investigation of VIVO 120™ resistance to pancreatic enzymes over 21 days and an in vivo application for sealing a simplified pancreatogastrostomy were conducted. Following pancreatic tail resection, a simplified pancreatogastrostomy was performed in 12 pigs, sealing the anastomosis between the pancreatic body and the gastric wall with VIVO 120™. One pig underwent acute testing (1-day survival), and 11 pigs were included in a long-term survival study (14-day survival). Animals were divided into three groups based on adhesive application: Group 1 (intraluminal application, n = 4), Group 2 (extraluminal application, n = 3), and Group 3 (intraluminal application with pancreatic duct obstruction and superficial pressure injection into the pancreatic resection plane, n = 4). Clinical observations, laboratory diagnostics, necropsy, and histological analyses were performed.
VIVO 120™ exhibited high resistance to enzymatic degradation. Histology revealed no adhesive remnants in Group 1, whereas in Group 2, the adhesive was integrated into the surrounding connective tissue. Both groups showed signs of only very mild pancreatitis distant to the adhesive, likely resulting from surgical trauma, and no signs of pancreatic fistula, while Group 3 exhibited severe pancreatitis and extensive fibroblastic proliferation following pressure application.
VIVO 120™ is biocompatible and resistant to pancreatic secretions, suggesting its potential for effective sealing of pancreatic anastomoses. However, application with pressure into pancreatic tissue should be avoided to prevent severe pancreatitis and extensive fibroblastic proliferation.
胰腺吻合术是胰十二指肠切除术的关键步骤，因为吻合失败伴术后胰瘘可导致高发病率和死亡率。虽然已经测试了各种基于纤维蛋白的密封剂，但由于其被胰液快速降解，其有效性有限。本研究旨在评估一种新型可生物降解的聚氨酯基粘合剂（VIVO 120™）在长期存活猪模型中用于胰腺吻合术中密封的适用性和生物相容性。
对VIVO 120™进行了为期21天的体外抗胰酶研究，并进行了体内应用以密封简化的胰胃吻合术。在切除胰尾后，对12头猪进行简化的胰胃吻合术，用VIVO 120™密封胰体与胃壁之间的吻合口。1头猪接受急性测试（存活1天），11头猪纳入长期存活研究（存活14天）。根据粘合剂的应用情况将动物分为三组：第1组（腔内应用，n = 4），第2组（腔外应用，n = 3），第3组（腔内应用并阻塞胰管，向胰腺切除平面进行表面加压注射，n = 4）。进行了临床观察、实验室诊断、尸检和组织学分析。
VIVO 120™表现出对酶降解的高抗性。组织学显示第1组无粘合剂残留，而第2组中，粘合剂融入周围结缔组织。两组均仅在远离粘合剂处显示出非常轻微的胰腺炎迹象，可能是手术创伤所致，且无胰瘘迹象，而第3组在加压后出现严重胰腺炎和广泛的成纤维细胞增殖。
VIVO 120™具有生物相容性且耐胰液，表明其在有效密封胰腺吻合口方面具有潜力。然而，应避免向胰腺组织加压应用，以防止严重胰腺炎和广泛的成纤维细胞增殖。
