Granulomatous inflammation and fibrosis in the porcine gastro-intestinal tract after application of TachoSil and Biodesign patches

Background. Leakage from gastrointestinal anastomoses (AL) is a serious complication associated with increased morbidity and mortality, prolonged hospitalization, and increased treatment costs. Moreover, AL in patients following colorectal resection is associated with an increased risk of cancer-related death and a reduced 5-year survival rate. Several studies imply that coating of gastrointestinal anastomoses with sealing devices such as fibrin glue and omental patches may enhance tissue healing and reduce the risk of AL. Purpose. The present study was undertaken to examine the short (3 days) and long-term (4 weeks) effects of a fibrin patch (TachoSil) and a biological mesh (Biodesign) on connective tissue synthesis when applied on fascia and the serosal surfaces of the intestine. Methods. TachoSil and Biodesign patches were applied on fascia, stomach, duodenum, small bowel, and colon in 8 pigs. The animals were sacrificed after 3 days and 4 weeks, respectively. Tissue samples from each anatomical site were obtained for histopathological examinations and histochemical analyses. Results. Significant histopathological changes were only observed in samples from pigs sacrificed after 4 weeks. The analyses revealed granulomatous inflammatory responses in the subserosa with fibrosis, neovascularization, and a high concentration of myofibroblasts. Focally, destruction of muscularis propria was noted. The observed inflammatory responses did not differ substantially between the two patches. Conclusion. The present study demonstrates that TachoSil and Biodesign promote connective tissue synthesis. This response has the potential to increase the long-term strength of the connective tissue thereby lowering the risk of AL.