Millions of patients every year undergo gastrointestinal surgery. While often lifesaving, sutured and stapled reconnections leak in around 10% of cases. Currently, surgeons rely on the monitoring of surrogate markers and clinical symptoms, which often lack sensitivity and specificity, hence only offering late-stage detection of fully developed leaks. Here, we present a holistic solution in the form of a modular, intelligent suture support sealant patch capable of containing and detecting leaks early. The pH and/or enzyme-responsive triggerable sensing elements can be read out by point-of-need ultrasound imaging. We demonstrate reliable detection of the breaching of sutures, in as little as 3 hours in intestinal leak scenarios and 15 minutes in gastric leak conditions. This technology paves the way for next-generation suture support materials that seal and offer disambiguation in cases of anastomotic leaks based on point-of-need monitoring, without reliance on complex electronics or bulky (bio)electronic implantables.

Biomedical Center Faculty of Medicine in Pilsen Charles University Prague Czech Republic

Department of Gynaecology Cantonal Hospital St Gallen Rorschacherstrasse 95 CH 9007 St Gallen Switzerland

Department of Surgery Faculty of Medicine in Pilsen Charles University Prague Czech Republic

Department of Visceral Surgery and Transplantation University Hospital Zurich CH 8091 Zurich Switzerland

Division of Chemistry and Chemical Engineering California Institute of Technology Pasadena CA 91125 USA

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Centre of Preclinical Research Milan 20122 Italy

Howard Hughes Medical Institute Pasadena CA 91125 USA

Laboratory for Mechanical Systems Engineering Department of Engineering Sciences Empa Swiss Laboratories for Materials Science and Technology Ueberlandstrasse 129 CH 8600 Dübendorf Switzerland

Laboratory for Particles Biology Interactions Department Materials Meet Life Swiss Federal Laboratories for Materials Science and Technology Lerchenfeldstrasse 5 CH 9014 St Gallen Switzerland

Nanoparticle Systems Engineering Laboratory Department of Mechanical and Process Engineering ETH Zurich Sonneggstrasse 3 CH 8092 Zurich Switzerland

Swiss HPB and Transplant Center Zurich Rämistrasse 100 CH 8091 Zurich Switzerland

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Surgical Sealant with Integrated Shape-Morphing Dual Modality Ultrasound and Computed Tomography Sensors for Gastric Leak Detection