Intestinal anastomotic leaking involving the release of chemically aggressive, microbially active fluids into the abdomen through  defective suture or staple sites, remains one of the most dreaded postoperative complications of abdominal surgery. Depending on the site and the patient condition, incidence rates of up to 21% and mortality as high as 27% are reported. Currently available surgical sealants only poorly address the issue, with most commonly used fibrin-based glues failing due to insufficient adhesion and chemical instability.

In this work, a leak-tight, chemically highly resistive and mucoadhesive hydrogel sealant, which is grafted on the surface of the intestinal wall via the use of a mutually interpenetrating network, is presented. This latter traverses both hydrogel and tissue yielding tissue compatible, deep anchorage. In contrast to clinically used, fibrin-based sealants (such as Tachosil), the developed poly(acrylamide-methyl acrylate-acrylic acid) (P(AAm-MA-AA)) adhesive patch does not degrade and exhibits high performance tissue adhesion under the harshest digestive conditions present in the abdominal cavity. The biocompatible hydrogel patch effectively seals anastomotic leaks in human relevant, ex vivo intestinal models, greatly surpassing commercial sealants (time to patch-failure >24 hours compared to 5 minutes for commonly used Tachosil). Importantly, the developed adhesive patch paves the way for the application of both mechanically and chemically robust sealants suitable for the treatment and prevention of intestinal anastomosis leaks.

[1] Anthis A, Hu X, Matter MT, Neuer AL, Wei KC, Schlegel AA, Starsich FHL, Herrmann IK, Advanced Functional Materials, 2021.

Keywords: hydrogel, surgical sealant, leak-prevention, abdominal surgery, sepsis