Postoperative anastomotic leaks are the most feared complications after gastric surgery. For diagnostics clinicians mostly rely on clinical symptoms such as fever and tachycardia, often developing as a result of an already fully developed, i.e., symptomatic, surgical leak. A gastric fluid responsive, dual modality, electronic-free, leak sensor system integrable into surgical adhesive suture support materials is introduced. Leak sensors contain high atomic number carbonates embedded in a polyacrylamide matrix, that upon exposure to gastric fluid convert into gaseous carbon dioxide (CO2 ). CO2 bubbles remain entrapped in the hydrogel matrix, leading to a distinctly increased echogenic contrast detectable by a low-cost and portable ultrasound transducer, while the dissolution of the carbonate species and the resulting diffusion of the cation produces a markedly reduced contrast in computed tomography imaging. The sensing elements can be patterned into a variety of characteristic shapes and can be combined with nonreactive tantalum oxide reference elements, allowing the design of shape-morphing sensing elements visible to the naked eye as well as artificial intelligence-assisted automated detection. In summary, shape-morphing dual modality sensors for the early and robust detection of postoperative complications at deep tissue sites, opening new routes for postoperative patient surveillance using existing hospital infrastructure is reported.

Biomedical Center Faculty of Medicine in Pilsen Charles University Alej Svobody 1655 76 Pilsen 32300 Czech Republic

Department of Imaging Methods Faculty of Medicine in Pilsen Charles University Alej Svobody 80 Pilsen 30460 Czech Republic

Department of Surgery and Transplantation Swiss HPB Centre University Hospital Zurich Rämistrasse 100 Zurich 8091 Switzerland

Department of Surgery Faculty of Medicine in Pilsen Charles University Alej Svobody 923 80 Pilsen 32300 Czech Republic

Diagnostic and Interventional Radiology University Hospital Zurich University of Zurich Rämistrasse 100 Zürich 8091 Switzerland

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

Nanoparticle Systems Engineering Laboratory Institute of Energy and Process Engineering ETH Zurich Sonneggstrasse 3 Zürich 8092 Switzerland

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

Transplantation Center Digestive Disease and Surgery Institute and Department of Immunity and Inflammation Lerner Research Institute Cleveland Clinic 9620 Carnegie Ave Cleveland OH 44106 United States

See more in PubMed

Sciuto A., Merola G., De Palma G. D., Sodo M., Pirozzi F., Bracale U. M., Bracale U., World J. Gastroenterol. 2018, 24, 2247. PubMed PMC

Famiglietti A., Lazar J. F., Henderson H., Hamm M., Malouf S., Margolis M., Watson T. J., Khaitan P. G., J. Thorac. Dis. 2020, 12, 1022. PubMed PMC

Hyman N. H., Surgeon 2009, 7, 31. PubMed

Simitian G. S., Hall D. J., Leverson G., Lushaj E. B., Lewis E. E., Musgrove K. A., McCarthy D. P., Maloney J. D., Surg. Open Sci. 2023, 11, 26. PubMed PMC

Persson S., Rouvelas I., Irino T., Lundell L., Dis. Esophagus 2017, 30, 1. PubMed

Deguchi Y., Fukagawa T., Morita S., Ohashi M., Saka M., Katai H., World J. Surg. 2012, 36, 1617. PubMed

Ballesta C., Berindoague R., Cabrera M., Palau M., Gonzales M., Obes. Surg. 2008, 18, 623. PubMed

Lee S., Carmody B., Wolfe L., DeMaria E., Kellum J. M., Sugerman H., Maher J. W., J. Gastrointest. Surg. 2007, 11, 708. PubMed

Finucane M. M., Stevens G. A., Cowan M. J., Danaei G., Lin J. K., Paciorek C. J., Singh G. M., Gutierrez H. R., Lu Y., Bahalim A. N., Farzadfar F., Riley L. M., Ezzati M., Lancet 2011, 377, 557. PubMed

Products – Health E Stats – Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults Aged 20 and Over: United States, 1960—1962 Through 2017—2018 . https://www.cdc.gov/nchs/data/hestat/obesity‐adult‐17‐18/obesity‐adult.htm (accessed: 2 January 2023).

Wang Y., Beydoun M. A., Min J., Xue H., Kaminsky L. A., Cheskin L. J., Int. J. Epidemiol. 2020, 49, 810. PubMed PMC

Morgan E., Arnold M., Camargo M. C., Gini A., Kunzmann A. T., Matsuda T., Meheus F., Verhoeven R. H. A., Vignat J., Laversanne M., Ferlay J., EClinicalMedicine 2022, 47, 101404. PubMed PMC

Xu Q.‐L., Li H., Zhu Y.‐J., Xu G., J. Cardiothorac. Surg 2020, 15, 163. PubMed PMC

van Boxel G. I., Ruurda J. P., van Hillegersberg R., Gastric Cancer 2019, 22, 909. PubMed PMC

Shi J., Wu Z., Wu X., Shan F., Zhang Y., Ying X., Li Z., Ji J., Ann. Surg. Oncol. 2022, 29, 1230. PubMed

Weil P. H., Buchberger R., World J. Surg. 1999, 23, 736. PubMed

Jaunoo S. S., Southall P. J., Int. J. Surg. 2010, 8, 86. PubMed

Colquitt J. L., Picot J., Loveman E., Clegg A. J., Cochrane Database Syst. Rev. 2014, 8, CD003641. PubMed PMC

Arterburn D. E., Telem D. A., Kushner R. F., Courcoulas A. P., JAMA, J. Am. Med. Assoc. 2020, 324, 879. PubMed

Nabavi N., Ghodsi A., Rostami R., Torshizian A., Jamialahmadi T., Jangjoo A., Nematy M., Bahari A., Ebrahimzadeh F., Mahmoudabadi E., Khadem‐Rezaiyan M., Rajabzadeh F., Goshayeshi L., Obes. Surg. 2022, 32, 1563. PubMed

Boersema G. S. A., Vennix S., Wu Z., Hekkert T. L., Duncker D.‐J. G. M., Lam K. H., Menon A. G., Kleinrensink G.‐J., Lange J. F, J. Surg. Res. 2017, 217, 84. PubMed

Bonanomi G., Prince J. M., McSteen F., Schauer P. R., Hamad G. G., Surg. Endosc. 2004, 18, 1620. PubMed

Trotter J., Onos L., McNaught C., Peter M., Gatt M., Maude K., MacFie J., Ann. R. Coll. Surg. Engl. 2018, 100, 230. PubMed PMC

Nordentoft T., Rømer J., Sørensen M., J. Invest. Surg. 2007, 20, 363. PubMed

Rosendorf J., Horakova J., Klicova M., Palek R., Cervenkova L., Kural T., Hosek P., Kriz T., Tegl V., Moulisova V., Tonar Z., Treska V., Lukas D., Liska V., Sci. Rep. 2020, 10, 1134. PubMed PMC

Yuk H., Varela C. E., Nabzdyk C. S., Mao X., Padera R. F., Roche E. T., Zhao X., Nature 2019, 575, 169. PubMed

Wu J., Yuk H., Sarrafian T. L., Guo C. F., Griffiths L. G., Nabzdyk C. S., Zhao X., Sci. Transl. Med. 2022, 14, eabh2857. PubMed

Ryu J. H., Kim H. J., Kim K., Yoon G., Wang Y., Choi G.‐S., Lee H., Park J. S., Adv. Funct. Mater. 2019, 29, 1900495.

Annabi N., Yue K., Tamayol A., Khademhosseini A., Eur. J. Pharm. Biopharm. 2015, 95, 27. PubMed PMC

Sanders L., Nagatomi J., Crit. Rev. Biomed. Eng. 2014, 42, 271. PubMed PMC

Takegawa Y., Takao T., Sakaguchi H., Nakai T., Takeo K., Morita Y., Toyonaga T., Kodama Y., Sci. Rep. 2022, 12, 6986. PubMed PMC

Anthis A. H. C., Hu X., Matter M. T., Neuer A. L., Wei K., Schlegel A. A., Starsich F. H. L., Herrmann I. K., Adv. Funct. Mater. 2021, 31, 2007099.

Yuan Y., Wu H., Ren X., Wang J., Liu R., Hu B., Gu N., Sci. China Mater. 2022, 65, 827.

Márquez M. F., Ayza M. F., Lozano R. B., del Mar Rico Morales M., Díez J. M. G., Poujoulet R. B, Obes. Surg. 2010, 20, 1306. PubMed

Makuuchi R., Irino T., Tanizawa Y., Bando E., Kawamura T., Terashima M., Surg. Today 2019, 49, 187. PubMed

Kalidasan V., Yang X., Xiong Z., Li R. R., Yao H., Godaba H., Obuobi S., Singh P., Guan X., Tian X., Kurt S. A., Li Z., Mukherjee D., Rajarethinam R., Chong C. S., Wang J.‐W., Ee P. L. R., Loke W., Tee B. C. K., Ouyang J., Charles C. J., Ho J. S., Nat. Biomed. Eng. 2021, 5, 1217. PubMed

Ben‐David M., Carmeli I., Orgad R., Nathansohn‐Levi B., Yered T., Shor E., Wasserberg N., J. Surg. Res. 2022, 278, 49. PubMed

Anthis A. H. C., Abundo M. P., Neuer A. L., Tsolaki E., Rosendorf J., Rduch T., Starsich F. H. L., Liska V., Schlegel A. A., Shapiro M. G., Herrmann I. K., Nat. Commun. 2022, 12, 7311. PubMed PMC

Wang C., Chen X., Wang L., Makihata M., Liu H.‐C., Zhou T., Zhao X. B., Science 2022, 377, 517. PubMed

Ultrasound Imaging: Advances and Applications (Eds: Sanches J. M., Laine A. F., Suri J. S.), Springer, Boston, MA: 2012.

Maar M., Lee J., Tardi A., Zheng Y.‐Y., Wong C., Gao J., Clin. Imaging 2022, 92, 63. PubMed

Moon S. W., Kim J. J., Cho D. G., Park J. K., J. Thorac. Dis. 2019, 11, S805. PubMed PMC

Grimminger P. P., Goense L., Gockel I., Bergeat D., Bertheuil N., Chandramohan S. M., Chen K., Chon S., Denis C., Goh K., Gronnier C., Liu J., Meunier B., Nafteux P., Pirchi E. D., Schiesser M., Thieme R., Wu A., Wu P. C., Buttar N., Chang A. C., Ann. N. Y. Acad. Sci. 2018, 1434, 254. PubMed

Lusic H., Grinstaff M. W., Chem. Rev. 2013, 113, 1641. PubMed PMC

Lal B. K., Hobson R. W., Pappas P. J., Kubicka R., Hameed M., Chakhtura E. Y., Jamil Z., Padberg F. T., Haser P. B., Durán W. N., J. Vasc. Surg. Venous Lymphat. Disord. 2002, 35, 1210. PubMed

Hsu J. C., Nieves L. M., Betzer O., Sadan T., Noël P. B., Popovtzer R., Cormode D. P., Wiley Interdiscip. Rev. Nanomed. Nanobiotechnol. 2020, 12, e1642. PubMed PMC

Hutchison A. J., Wilson R. J., Garafola S., Copley J. B., Nephrology 2016, 21, 987. PubMed PMC

McLauchlan G., Fullarton G. M., Crean G. P., McColl K. E., Gut 1989, 30, 573. PubMed PMC

Tarn A. C., Lapworth R., Ann. Clin. Biochem. 2010, 47, 397. PubMed

Simmen H.‐P., Blaser J., Am. J. Surg. 1993, 166, 24.. PubMed

diZerega G. S., Rodgers K. E., in The Peritoneum (Eds: diZerega G., Rodgers K. E.), Springer, New York: 1992, pp. 26–56.

Nardo T., Carmagnola I., Ruini F., Caddeo S., Calzone S., Chiono V., Ciardelli G., in Kidney Transplantation, Bioengineering and Regeneration (Eds: diZerega G. S., Rodgers K. E.), Academic Press, San Diego, CA: 2017, pp. 901–921.

Darnell M. C., Sun J.‐Y., Mehta M., Johnson C., Arany P. R., Suo Z., Mooney D. J., Biomaterials 2013, 34, 8042. PubMed PMC

Hellebrekers B. W. J., Trimbos‐Kemper G. C. M., van Blitterswijk C. A., Bakkum E. A., Trimbos J. B. M. Z., Hum. Reprod. 2000, 15, 1358. PubMed

Hu H., Zhai X., Li W., Ji S., Dong W., Chen W., Wei W., Lu Z., iScience 2022, 25, 104619. PubMed PMC

Chen X., Zhang Y., Yu W., Zhang W., Tang H., Yuan W.‐E., J. Nanobiotechnol. 2023, 21, 129. PubMed PMC

F04 Committee , Test Method for Strength Properties of Tissue Adhesives in T‐Peel by Tension Loading, ASTM International, West Conshohocken, PA: 2016.

Pickhardt P. J., Graffy P. M., Zea R., Lee S. J., Liu J., Sandfort V., Summers R. M., Lancet Digit Health 2020, 2, e192. PubMed PMC

Lee S., Summers R. M., Radiol. Clin. 2021, 59, 987. PubMed

Shen Y.‐T., Chen L., Yue W.‐W., Xu H.‐X., Eur. J. Radiol. 2021, 139, 109717. PubMed

Mudie D. M., Murray K., Hoad C. L., Pritchard S. E., Garnett M. C., Amidon G. L., Gowland P. A., Spiller R. C., Amidon G. E., Marciani L., Mol. Pharmaceutics 2014, 11, 3039. PubMed

Assessment, U. E. N. C. for E. Barium and Compounds CASRN 7440‐39‐3 | IRIS | US EPA, ORD, https://iris.epa.gov/ChemicalLanding/&substance_nmbr=10 (accessed: 22 December 2022).

Treier R., Aroua A., Verdun F. R., Samara E., Stuessi A., Trueb P. R., Radiat. Prot. Dosim. 2010, 142, 244. PubMed

Sartoretti T., Mergen V., Jungblut L., Alkadhi H., Euler A., Acad. Radiol. 2023, 30, 461. PubMed

Regensburg N. I., Kok P. H. B., Zonneveld F. W., Baldeschi L., Saeed P., Wiersinga W. M, Mourits M. P., Invest. Opthalmol. Visual Sci. 2008, 49, 1758. PubMed

Shrimpton P. C., Assessment of Patient Dose in CT, NRBC, Chilton: 2004.

Shrimpton P. C., Hillier M. C., Lewis M. A., Dunn M., Br. J. Radiol. 2006, 79, 968. PubMed

Tsalafoutas I. A., World J. Radiol. 2010, 2, 262. PubMed PMC

Csendes A., Burdiles P., Burgos A. M., Maluenda F., Diaz J. C., Obes. Surg. 2005, 15, 1252. PubMed

Rached A. A., World J. Gastroenterol. 2014, 20, 13904. PubMed PMC

Wu J., Yuk H., Sarrafian T. L., Guo C. F., Griffiths L. G., Nabzdyk C. S., Zhao X., Sci. Transl. Med. 2022, 14, eabh2857. PubMed

Cui C., Wu T., Chen X., Liu Y., Li Y., Xu Z., Fan C., Liu W., Adv. Funct. Mater. 2020, 30, 2005689.

Rosset A., Spadola L., Ratib O., J. Digit. Imaging 2004, 17, 205. PubMed PMC