Small intestine submucosa: intrinsic and anastomotic tensile strength of SIS using laser welding, fibrin glue, vascular closure staples, endo-GIA staples and sutures

Small intestinal submucosa (SIS) has been used for the reconstruction of ur inary-tract segments. Its utility as a graft material for bladder reconstru ction has been somewhat limited by the 7 cm circumference of the porcine sm all intestine. Accordingly we studied several anastomotic techniques using an in vitro model. Tensometry data were collected for: dehydrated SIS (2 cm x 1 cm); SIS hydrated for 5, 10, 15, 60, 120 and 180 min; and SIS anastomo sed to self and to porcine bladder using: (a) 4-0 Vicryl sutures, (b) KTP l aser welding with 50% albumin solder, (c) fibrin glue, (d) vascular closure dips (VCS), or (e) endo-GIA vascular staples. Tensometry for porcine bladd er, dehydrated SIS and SIS hydrated for 5, 10, 15 and 60 min was similar (5 .0-6.7 N). SIS hydrated for 120 and 180 min had significantly higher breaki ng strengths (10.9 and 13.2 N, respectively; p < 0.05). Suturing and endo-G IA stapling of SIS to self and bladder produced anastomoses equivalent to t he strength of intact SIS. The KTP laser, fibrin glue and VCS produced weak anastomoses, all < 1.0 N. Hydration of SIS for 2 h nearly doubles the tens ile strength of the material. Suturing and endo-GIA stapling of strips of S IS produces an anastomosis equivalent in strength to native SIS.