To the Editor:
We read with interest the article by Oh et al1 in which polytetraflouroethylene (PTFE) patches were tested experimentally for the repair of the gastrointestinal tract. Actually, the idea of replacing a segment of the intestine wall with synthetic material is not well accepted and still viewed with skepticism, even when some studies had proven its efficacy and safety. Furthermore, the evidence presented so far in animal experimentation is strong enough to support its feasibility in a human digestive tract.
The qualities of the PTFE as a material are no issue of argument among different authors.1–3 However, the applications and indications that can be given to PTFE are indeed a matter of disagreement. It is obvious that the use of synthetic patches will not reach the degree of gold standard therapy; therefore, the future studies should be aimed to determine the specific indications of PTFE patches. We have tested PTFE in digestive as well as in biliary tract, and our results were good enough to consider PTFE as a therapeutic option in our armamentarium.
We proposed the use of PTFE ring-reinforced vascular grafts for the repair of the main bile ducts, replacing the whole injured segment instead of just covering the defect.3 The results after experimentation were promising, suggesting that this kind of replacement is feasible with a minimum complication rate (no bile stasis and no stricture formation). We also had a patient in which a duodenal stump suffered suture dehiscence several times as the result of an extremely edematous duodenal wall. A PTFE tube to exteriorize the defect and a PTFE patch to cover it once the edema disappeared served for its repair with a consequent remission of the edema and recovery of the patient.4 It is our belief that in situations in which edema and friability of the gut wall makes impossible the primary repair, fixation with PTFE grafts are an excellent alternative.
Another goal should be to determine the safety and cost-effectiveness of PTFE in comparison with other materials. We also support the idea of patches made of organic material. The omentum,5 ligamentum teres hepatis,6 and falciform ligament7 are a few examples of organic materials tested so far. Our experience is with human duramadre8 and human pericardium (currently under analysis), both in animal models. A liofilized human duramadre tube served us as a replacement of an upper esophagus segment in dogs; moderate stenosis that manifested as dysphagia to solids developed in 40% of the cases. This design may offer a new surgical alternative for patients with malign stenosis. Human pericardium seems to have the physical characteristics that a gastrointestinal patch need and with good acceptability.9
In conclusion, the use of synthetic and organic patches for the alimentary tract repair is obtaining considerable importance because several experimental studies showed good results while testing the aforementioned grafts. Human testing must be encouraged so that this type of surgical repair can have its definitive indications.
Néstor A. Gómez MD, FACS, FACG, Prof
Jorge A. Zapatier MD
Paola E. Vargas MD
Guayaquil, Ecuador
ngomez@gye.satnet.net
REFERENCES
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