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Marine-inspired molecular mimicry generates a drug-free, but immunogenic hydrogel adhesive protecting surgical anastomosis

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Bioactive Materials 2021年第3期6卷 770-782页

作者： Jinjian Huang Yungang Jiang Ye Liu Yanhan Ren Ziyan Xu Zongan Li Yun Zhao Xiuwen Wu Jianan Ren PLA Key Laboratory of Trauma and surgical Infections Research Institute of General SurgeryJinling HospitalSchool of MedicineSoutheast UniversityNanjing210009China Chicago Medical School Rosalind Franklin University of Medicine and ScienceNorth ChicagoIL 60064USA School of Medicine Nanjing UniversityNanjing210093China Jiangsu Key Laboratory of 3D Printing Equipment and Manufacturing NARI School of Electrical and Automation EngineeringNanjing Normal UniversityNanjing210042China Gastrointestinal Unit and Center for the Study of Inflammatory Bowel Disease Massachusetts General HospitalHarvard Medical SchoolBostonMA02114USA

Herein,we report the synthesis of a biomimic hydrogel adhesive that addresses the poor healing of surgical ***-conjugated xanthan gum(Da-g-Xan)is fabricated using deep insights into the molecular similarity between mussels'adhesive and dopamine as well as the structural similarity between barnacle cement proteins and xanthan *** hydrogel mimics marine animals’adherence to wet tissue *** applying this adhesive to colonic anastomosis in a rat model,protective effects were shown by significantly improving the bursting ***,the architecture of Da-g-Xan hydrogel is maintained by dynamic intermolecular hydrogen bonds that allow the quick release of *** free Da-g-Xan can regulate the inflammatory status and induce type 2 macrophage polarization(M2)by specifically interacting with mannose receptors(CD206)revealed by RNA-sequencing and molecular binding ***,an appropriate microenvironment for tissue healing is created by the secretion of chemokines and growth factors from M2 macrophages,strengthening the fibroblast migration and proliferation,collagen synthesis and epithelial ***,this study demonstrates an unprecedented strategy for generating an adhesive by synergistic mimicry inspired by two marine animals,and the results show that the Da-g-Xan adhesive augments native tissue regenerative responses,thus enabling enhanced recovery following surgical anastomosis.

关键词： Marine animals Non-covalent hydrogel Xanthan gum Mannose receptors surgical anastomosis

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Iatrogenic bile duct injuries:Etiology,diagnosis and management

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World Journal of Gastroenterology 2009年第33期15卷 4097-4104页

作者： Beata Jab■ońska Pawe■ Lampe Department of Digestive Tract Surgery University Hospital of the Medical University of Silesia

Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI is very important for surgeons and gastroenterologists, because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death. Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popular and simple classification of IBDI is the Bismuth scale. Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered. Different surgical reconstructions are performed in patients with IBDI. According to the literature, Roux- en-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors. In the opinion of some authors, a more physiological and equally effective type of reconstruction is end- to-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI; the Terblanche scale, based on clinical biliary symptoms, is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

关键词： Iatrogenic disease Biliary drainage Bile ducts Cholecystectomy Roux-en-Y anastomosis surgical injuries surgical anastomosis

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Endoscopic stenting for recurrence-related colorectal anastomotic site obstruction:Preliminary experience

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World Journal of Gastroenterology 2014年第38期20卷 13936-13941页

作者： Jung Ho Kim Jong Joon Lee Jae Hee Cho Kyoung Oh Kim Jun-Won Chung Yoon Jae Kim Kwang An Kwon Dong Kyun Park Ju Hyun Kim Department of Internal Medicine Gachon University Gil Medical Center

AIM: To evaluate the efficacy of stents in treating patients with anastomotic site obstructions due to cancer recurrence following colorectal surgery.

关键词： Colorectal neoplasms Endoscopy Intestinal obstruction Stents surgical anastomosis

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Stem cell therapy applied for digestive anastomosis: Current state and future perspectives

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World Journal of Stem Cells 2022年第1期14卷 117-141页

作者： Jacobo Trébol Tihomir Georgiev-Hristov Isabel Pascual-Miguelañez Hector Guadalajara Mariano García-Arranz Damian García-Olmo Servicio de Cirugía General y del Aparato Digestivo Complejo Asistencial Universitario de SalamancaSalamanca 37007Spain Departamento de Anatomía e Histología Humanas Universidad de SalamancaSalamanca 37007Spain Servicio de Cirugía General y del Aparato Digestivo Hospital General Universitario de VillalbaMadrid 28400Spain Servicio de Cirugía General y del Aparato Digestivo Hospital Universitario La PazMadrid 28046Spain Servicio de Cirugía General y del Aparato Digestivo Hospital Universitario Fundación Jiménez DíazMadrid 28040Spain Grupo de Investigación en Nuevas Terapias Instituto de Investigación Sanitaria-Fundación Jiménez DíazMadrid 28040Spain Damian García-Olmo Departamento de CirugíaUniversidad Autónoma de MadridMadrid 28029Spain Servicio de Cirugía General y del Aparato Digestivo Hospital Universitario Fundación Jiménez Díaz y Grupo Quiron-Salud MadridMadrid 28040Spain

BACKGROUND Digestive tract resections are usually followed by an *** leakage,normally due to failed healing,is the most feared complication in digestive surgery because it is associated with high morbidity and *** technical and technological advances and focused research,its rates have remained almost unchanged the last *** the last two decades,stem cells(SCs)have been shown to enhance healing in animal and human studies;hence,SCs have emerged since 2008 as an alternative to improve anastomoses *** To summarise the published knowledge of SC utilisation as a preventative tool for hollow digestive viscera anastomotic or suture *** PubMed,Science Direct,Scopus and Cochrane searches were performed using the key words“anastomosis”,“colorectal/colonic anastomoses”,“anastomotic leak”,“stem cells”,“progenitor cells”,“cellular therapy”and“cell therapy”in order to identify relevant articles published in English and Spanish during the years of 2000 to *** employing SCs,performing digestive anastomoses in hollow viscera or digestive perforation sutures and monitoring healing were finally *** lists from the selected articles were reviewed to identify additional pertinent *** Given the great variability in the study designs,anastomotic models,interventions(SCs,doses and vehicles)and outcome measures,performing a reliable meta-analysis was considered impossible,so we present the studies,their results and *** Eighteen preclinical studies and three review papers were identified;no clinical studies have been published and there are no registered clinical *** studies,mainly in rat and porcine models and occasionally in very adverse conditions such as ischaemia or colitis,have been demonstrated SCs as safe and have shown some encouraging morphological,functional and even clinical *** SCs are mostly employed,and delivery routes are mainly local

关键词： surgical anastomosis Anastomotic leak Digestive system surgical procedure Cell transplantation Cell therapy Stem cells Tissue engineering

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Clinical Significance of Recurrent Laryngeal Nerve Exposure During Esophagogastric anastomosis of the Neck

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Clinical oncology and cancer researeh 2010年第3期7卷 206-209页

作者： Chun-hong YANG Xiang-yang WEI Baoding Maternal and Child Health Hospital Baoding 071000 Hebei Province China. Department of Head-neck Surgery Baoding Cancer Hospital Baoding 071000 Hebei Province China.

OBJECTIVE To investigate the clinical value in a comparison between intraoperative exposure and non-exposure of the recurrent laryngeal nerve （RLN） of the neck during left neck esophagogastric anastomosis following resection of carcinomas of the middle and inferior-segment esophagus. METHODS From January 2003 to April 2009, 237 patients were selected to undergo resection of esophageal squamous carcinoma via posteroexternal incision of the left chest plus gastroesophageal anastomosis at the left neck incision. The 237 cases were divided into 2 groups： 115 of the total cases were in group A （the study group）, cases of resections with neck RLN exposure. Of the patients in this group, 64 were male and 51 female, with a mean age of 49 ranging from 31 to 73 years. Another 122 cases were in group B （the control group）, cases of resections without neck RLN exposure. In this group, 51 of the patients were male and 71 female, with a mean age of 45 ranging from 33 to 75 years. In the 2 groups, there were 9 cases in total with symptoms induced by RLN injury. RESULTS Hoarseness, choking cough when drinking, and difficult expectoration were found in 1 of the cases （1/115） in group A （0.087%）, while there were 8 cases （8/122） presenting with these symptoms in group B （6.5%）. There is statistical *** in the *** of RLN injury between the 2 groups （P 〈 0.05）. CONCLUSION Analysis of study cases of esophageal carcinoma resection with left-neck esophagogastric anastomosis in the 2 groups indicated that the exposure of the RLN in group A resulted in an obviously lower rate of neck RLN injury after the surgery, compared to group B, where the RLN was not exposed. Exposure can lead to the avoidance of complications induced by RLN injury, such as dysarthria and choking cough when eating. As a result, satisfactory expectoration, which would diminish the incidence of pulmonary complications, can be reached allowing the patients to recover as early as possible. The results of our

关键词： esophageal neoplasm surgical anastomosis recurrent laryngeal nerve

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Covered nitinol stents for the treatment of esophageal strictures and leaks

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World Journal of Gastroenterology 2010年第18期16卷 2260-2264页

作者： Davide Bona Letizia Laface Luigi Bonavina Emmanuele Abate Moshe Schaffer Ippazio Ugenti Stefano Siboni Rosaria Carrinola Department of Medical and surgical Sciences Division of General SurgeryIRCCS Policlinico San DonatoUniversity of Milan Medical School

AIM:To compare 2 different types of covered esophageal nitinol stents(Ultraflex and Choostent) in terms of efficacy,complications,and long-term ***:A retrospective review of a consecutive series of 65 patients who underwent endoscopic placement of an Ultraflex stent(n = 33) or a Choostent(n = 32) from June 2001 to October 2009 was ***:Stent placement was successful in all patients without hospital *** significant differences in patient discomfort and complications were observed between the Ultraflex stent and Choostent *** median follow-up time was 6 mo(interquartile range 3-16 mo).Endoscopic reintervention was required in 9 patients(14%) because of stent migration or food *** significant difference in the rate of reintervention between the 2 groups was observed(P = 0.8).The mean dysphagia score 1 mo after stent placement was 1.9 ± 0.3 for the Ultraflex stent and 2.1 ± 0.4 for the Choostent(P = 0.6).At 1-mo follow-up endoscopy,the cover membrane of the stent appeared to be damaged more frequently in the Choostent group(P = 0.34).Removal of the Choostent was possible up to 8 wk without ***:Ultraflex and Choostent proved to be equally reliable for palliation of dysphagia and *** of the Choostent was easy and safe under mild sedation.

关键词： Dysphagia Esophageal neoplasms Endoscopy Palliative care surgical anastomosis Stricture Neoadjuvant therapy Self-expanding metal stents

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Endoscopic management of biliary strictures after liver transplantation

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World Journal of Gastroenterology 2009年第30期15卷 3725-3733页

作者： Emmanuelle D Williams Peter V Draganov Division of Gastroenterology University of FloridaGainesvilleFL 32610-0214United States

Bile duct strictures remain a major source of morbidity after orthotopic liver transplantation (OLT). Biliary strictures are classifi ed as anastomotic or non-anastomotic strictures according to location and are defi ned by distinct clinical behaviors. Anastomotic strictures are localized and short. The outcome of endoscopic treatment for anastomotic strictures is excellent. Nonanastomotic strictures often result from ischemic and immunological events, occur earlier and are usually multiple and longer. They are characterized by a far less favorable response to endoscopic management, higher recurrence rates, graft loss and need for retransplantation. Living donor OLT patients present a unique set of challenges arising from technical factors, and stricture risk for both recipients and donors. Endoscopic treatment of living donor OLT patients is less promising. Current endoscopic strategies for biliary strictures after OLT include repeated balloon dilations and placement of multiple side-by-side plastic stents. Lifelong surveillance is required in all types of strictures. Despite improvements in incidence and long term outcomes with endoscopic management, and a reduced need for surgical treatment, the impact of strictures on patients after OLT is signifi cant. Future considerations include new endoscopic technologies and improved stents, which could potentially allow for a decreased number of interventions, increased intervals before retreatment, and decreased reliance on percutaneous and surgical modalities. This review focuses on the role of endoscopy in biliary strictures, one of the most common biliary complications after OLT.

关键词： Anastomotic strictures Bile duct diseases Endoscopic retrograde cholangiopancreatography Orthotopic liver transplantation surgical anastomosis

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Sutureless choledochoduodenostomy with an intraluminal degradable stent in dog model

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Chinese Medical Journal 2011年第13期124卷 1999-2003页

作者： ZHU Ling-hua LIANG Xiao LIN Hui WANG Yi-fan ZHU Yi-ping CAI Xiu-jun Department of General Surgery Sir Run Run Shaw HospitalCollege of Medicine the Institute of Minimally Invasive SurgeryZhejiang University Hangzhou Zhejiang 310016 China

Background It is difficult and time-consuming for carrying out conventional hand-sewn bilioenteric anastomosis, especially for small bile duct anastomosis and laparoscopic procedure. In order to simplify it, we have developed a novel procedure of sutureless bilioenteric anastomosis with an intraluminal degradable stent. This study aimed to evaluate the feasibility and safety of this technique with cholangioduodenostomy in dog model. Methods A patent intraluminal degradable stent tube for sutureless choledochoduodenostomy in dog model was made with polylactic acid in diameter of 3 mm or 4 mm. Thirty-eight dogs were randomly divided into to a stent group （SG, n=20） and a control group （CG, n=18）. Dogs in the SG underwent sutureless choledochoduodenostomy with intraluminal stent, while the CG underwent conventional choledochoduodenostomy （single layer discontinuous anastomosis with absorbable suture）. Dogs of each group were divided into 4 subgroups according to time of death （1,3, 6, and 12 months postoperatively） to evaluate the healing of anastomosis. Operation time, intraoperative tolerance pressure of anastomosis, rate of postoperative bile leakage, bursting pressure of anastomosis were compared between the two groups. anastomosis tissue was observed afterwards by pathology evaluation, hydroxyproline content, serum bilirubin, liver enzyme level and magnetic resonance cholangio-pancreatography （MRCP） to assess the stricture. Results All procedures were completed successfully. The surgical time of the SG was significantly less than the CG （SG：（19.2±4.3） minutes, vs. CG：（29.2±7.1） minutes, P=0.000）. One bile leakage was occurred in either group. No significant difference of intraoperative tolerance pressure of anastomosis, rate of bile leakage and postoperative bursting pressure of anastomosis, anastomotic stricture, hydroxyproline content, serum bilirubin and liver enzyme level was found between the two groups. MRCP showed no anastomosis stricture and obstruction

关键词： stent surgical anastomosis duodenum common bile duct

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Clinical outcomes of self-expandable metal stents in palliation of malignant anastomotic strictures caused by recurrent gastric cancer

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World Journal of Gastroenterology 2009年第28期15卷 3523-3527页

作者： Yu Kyung Cho Sang Woo Kim Kwan Woo Nam Jae Hyuck Chang Jae Myung Park Jeong-Jo Jeong In Seok Lee Myung-Gyu Choi In-Sik Chung Department of Internal Medicine The Catholic University of Korea

AIM： To examine the technical feasibility and clinical outcomes of the endoscopic insertion of a selfexpandable metal stent （SEMS） for the palliation of a malignant anastomotic stricture caused by recurrent gastric cancer. METHODS： The medical records of patients, who had obstructive symptoms caused by a malignant anastomotic stricture after gastric surgery and underwent endoscopic insertion of a SEMS from January 2001 to December 2007 at Kangnam St Mary＇s Hospital, were reviewed retrospectively. RESULTS： Twenty patients （15 male, mean age 63 years） were included. The operations were a total gastrectomy with esophagojejunostomy （n = 12）, subtotal gastrectomy with Billroth-Ⅰ reconstruction （n = 2） and subtotal gastrectomy with Billroth- Ⅱ reconstruction （n = 8）. The technical and clinical success rates were 100% and 70%, respectively. A small bowel or colon stricture was the reason for a lack of improvement in symptoms in 4 patients. Two of these patients showed improvement in symptoms after another stent was placed. Stent reobstruction caused by tumor ingrowth or overgrowth occurred in 3 patients （15%） within 1 mo after stenting. Stent migration occurred with a covered stent in 3 patients who underwent a subtotal gastrectomy with Billroth-Ⅱ reconstruction. Two cases of partial stent migration were easily treated with a second stent or stent repositioning. The median stent patency was 56 d （range, 5-439 d）. The median survival was 83 d （range, 12-439 d）. CONCLUSION： Endoscopic insertion of a SEMS provides safe and effective palliation of a recurrent anastomotic stricture caused by gastric cancer, A meticulous evaluation of the presence of other strictures before inserting the stent is essential for symptom improvement.

关键词： Stents surgical anastomosis Stricture Endoscopic gastrointestinal surgery Stomach neoplasms

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Simulation and Experimental Study of Staple Line Reinforcement Surgery

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Journal of Biomedical Science and Engineering 2024年第4期17卷 83-95页

作者： Chengjie Hu Jian Zhang School of Health Science and Engineering University of Shanghai for Science and Technology Shanghai China Department of Colorectal Surgery The Second Affiliated Hospital of Naval Medical University Shanghai China

The aim of this study was to evaluate the effectiveness of BM (basement membrane) and SIS (small intestine submucosa) composite extracellular matrix staple line reinforcement in surgical procedures through finite element modelling simulations and leak-proof performance experiments. The mechanical analyses of soft tissues with and without staple line reinforcement were performed by establishing finite element models of three tissues, namely, stomach, intestine and lungs, under the use scenarios of different anastomosis staple models;and the leak-proof performance of the staple line reinforcement was evaluated by simulating leak-proof experiments of gastric incision margins, intestinal sections, and lung incision margins in vitro. The results showed that the equivalent average stresses of the staple line reinforcement were increased by 20 kPa-68 kPa in gastric and intestinal tissues, and 8 kPa-22 kPa in lung tissues. and that the BM and SIS composite extracellular matrix staple line reinforcement could strengthen the anastomotic structure, and at the same time disperse the high stresses of the anastomosed tissues, which could effectively reduce the postoperative complications such as anastomotic bleeding and anastomotic leakage, and provide a safer and more effective optimized design for surgical mechanical anastomosis. It can effectively reduce postoperative complications such as anastomotic bleeding and anastomotic leakage, and provide a safer and more effective optimized design for surgical mechanical anastomosis.

关键词： Staple Line Reinforcement surgical anastomosis Soft Tissue Damage Finite Element Analysis Leak-Proof Performance ExperimentsStaple cartridge

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