Background
Postoperative dehiscence is a major complication of digestive anastomosis (DA). Biologic materials have been introduced as reinforcement of abdominal wall hernia in contaminated setting. Our previous experimental studies on pigs, based on biochemical, tensiometric, and immunohistochemical evidences , showed that bovine pericardium patch (BPP) is also effective as reinforcement of DA, significantly improving healing process, and preventing leakage in cases of iatrogenic perforation. In this preliminary study we propose the use of BPP as reinforcement of DA in human.

Materials and Methods
From 2011 to 2013, 28 patients (11 F, 17 M; mean age: 69 y, range: 36-80 y) were treated at two Units of general surgery in Italy. In 18 (Group A) a mechanical high-risk anastomosis was reinforced by BPP fixed by sutures around the anastomotic line, and in 10 (Group B), in which a postoperative anastomotic leak appeared, a direct suture overlaid through BPP was performed. Group A included large bowel (N=5), small bowel (N=6), esophagojejunal (N=6), and pancreatojejunal anastomoses (N=3); Group B included 8 anastomotic leakages (N=8).

Results
No mortality was observed. In Group A all anastomoses healed without complications. In Group B leakage was clinically and radiologically stopped, and patients showed an uneventful follow- up. The medium follow-up was 29 months (range:1-36).

Conclusion
This preliminary experience in human confirms that the use of BPP wrapping digestive anastomosis improves the healing process in high-risk conditions; moreover, it successfully manages the appearance of anastomotic failure. Further prospective studies with larger series are needed to validate this method.