A Pro-Healing and Antibacterial Bio-Based Hydrogel Barrier for the Prevention of Intestinal Anastomotic Leakage

Postoperative leakage at the colorectal anastomosis is recognized as a significant and serious complication. Its pathogenic factors are complex, the onset process is hidden, and it is often complicated with severe abdominal infection, which leads to sepsis and even multiple organ failure. In order to develop a new type of multifunctional biomaterial which can prevent intestinal bacterial translocation, intestinal fluid spillage and promote the healing of intestinal anastomosis, we prepared a multifunctional temperature-sensitive extracellular matrix hydrogel with the extracellular matrix (ECM) of porcine small intestinal submucosa (SIS) physically modified by boric acid and 4-ARM-PEG-SC as raw materials, in order to avoid abdominal infection and prevent anastomotic leakage. A series of experiments showed that the prepared hydrogel had stable structure, could resist the erosion of digestive juice in physiological range and had good tissue adhesion and mechanical properties, excellent antiexplosion ability and self-healing. Combined with its injectability, it could effectively seal the anastomosis. In vitro experiments showed that the hydrogel had effective antidigestion ability, good antibacterial properties, excellent cell and blood compatibility, as well as antioxidant and anti-inflammatory capabilities. Experiments revealed that the hydrogel could effectively optimize the local microenvironment of the anastomosis, promote the tissue repair of the anastomosis and effectively reduce the incidence of colonic anastomotic leakage in rats by promoting the key factors of cell proliferation, facilitating vascular formation and curtailing the expression of pro-inflammatory factors. The findings of this study pave the way for novel strategies in creating multifunctional materials designed to prevent and manage anastomotic leakage.