Physical pressure resistance of gastrointestinal anastomotic site via polyglycolic acid promoting fibrosis

Abstract Anastomotic-leakage incidence has been reported to be reduced on using polyglycolic acid (PGA) sheets as reinforcing materials; however, there is insufficient evidence regarding the reinforcement mechanism. Therefore, we investigated effects of PGA sheets on gastrointestinal anastomoses in rats. In the first approach, five rats underwent laparotomy; the PGA sheet was pasted onto the normal cecal wall. After five days, the cecum was removed and histologically evaluated. In the second approach, ten rats were randomly divided into two groups of five animals each. The rats underwent laparotomy; the cecal wall was sutured after a full-thickness incision. In the PGA group, a PGA sheet was used to cover the suture area. After 5 days, the cecum was removed, and the physical pressure resistance was evaluated. We confirmed the growth of a fibrous capsule measuring 855 (648–1048) µm outside the cecal serosa in the first approach. The median pressure resistance in the second approach was 57 (45.0–90.0) and 90 (82.5–94.5) mmHg in Control and PGA groups, respectively. The pressure resistance was significantly higher in the PGA group (p = 0.046). In summary, the PGA sheet may form a barrier of fibrosis on the intestinal wall and provide reinforcement to prevent anastomotic leakage.