Anastomotic leaks after intestinal surgeries aren’t just a statistic – they’re a painful reality with life-changing consequences for patients, endless frustration for surgeons and immense costs for healthcare systems worldwide. But what if there was a way to rewrite this story? Groningen-based Implican is on a mission to do just that. Implican is developing a solution that could replace current surgical techniques and improve outcomes for hundreds of thousands of patients. We sat down with Klaas Havenga, surgeon and founder of Implican, and Ivo Kooijman, the company’s CEO, to hear how they’re tackling this challenge head-on.
A hidden risk with serious consequences
During intestinal surgeries, two sections of the bowel are often reconnected. In the Western world alone, an estimated 400,000 of these procedures are performed annually. The big challenge? Anastomotic leaks. Official Dutch statistics estimate that 8% of patients experience a leak, though the real number may be much higher.
“When a leak occurs just two days after surgery, it can lead to peritonitis, landing patients in intensive care,” Klaas Havenga explains. Even minor leaks can cause significant problems. “I’ve seen cases where a patient seemed to be recovering, only to return 10 days post-op with a hole in their bowel,” Klaas shares. “What follows could mean another hospital stay, and sometimes, the temporary use of a stoma. It’s frustrating for everyone involved.”
Lifelong impact on patients, endless frustration for surgeons
Anastomotic leaks are a persistent global challenge, the top concern for every colorectal surgeon. Klaas Havenga: “Everyone is working to reduce the risk, but it’s a persistent problem that keeps coming back.”
For patients, the consequences are life-changing. A leak can lead to a lifetime with a stoma or chronic issues, like needing to visit the bathroom 20 times a day. “Some people are so afraid of complications that they don’t even want to attempt closure of the stoma,” adds Ivo Kooijman. “They deliberately choose to keep their stoma.” Addressing these frustrations requires rethinking the tools and methods surgeons rely on.
A fresh approach to intestinal connections
For decades, surgeons have struggled with the limitations of current techniques, especially in deep pelvic surgeries. Klaas explains: “Traditionally, we use staplers or sutures to connect intestines. Those staplers were developed in the 1960s. The problem is that this approach creates secondary wound healing – the body has to clean up the damage before the wound can start to heal. That delay leaves plenty of room for bacteria to cause leaks.” “You’re essentially creating a mess,” Ivo adds. “It’s inefficient and risky.”
Implican’s innovation: primary wound healing
Implican’s solution flips the script on traditional techniques. Instead of staples, they use rings to compress the intestinal layers securely together. Havenga explains: “The middle layer of the intestine, the submucosa, is perfect for primary wound healing. By pressing the intestines together at this layer in a clean, bacteria-free environment, the wound can heal directly – quickly, strongly, and with minimal inflammation.” This approach eliminates the collateral damage and inflammation caused by conventional staplers.
The Implican rings are temporary and leave the body after wound healing. Early tests on pigs have shown promising results. “We noticed inflammation subside within days, and after seven days, the rings released on their own,” Kooijman shares.
Reducing overall treatment costs by up to 55%
Anastomotic leaks don’t just impact patients – they take a heavy toll on healthcare systems and the environment. Treating a leak is an expensive, resource-intensive process. “Instead of being discharged from the hospital after two days, a patient can spend up to 30 days in the hospital with multiple re-operations or a definitive stoma,” Kooijman explains.
Beyond the financial burden, there’s also a significant environmental cost. “Our applicator, the device used to establish the rings to compress the intestinal layers, is reusable. Unlike the disposable tools currently in use,” Havenga points out. “And treating a single leak generates an average of 1,300 kilograms of CO₂. By preventing leaks, our device delivers another huge environmental benefit on top of already being reusable.”
Implican’s innovation isn’t just about improving outcomes for patients – it’s also about lowering costs for healthcare providers. By reducing complications, it offers long-term savings. ““Even if our device is more expensive upfront, it can cut overall treatment costs by up to 55%. Reducing complications directly contributes positively to the availability of nursing staff, intensive care and hospital beds”, Kooijman said. . With these promising benefits in mind, Implican is ready to take the next major step.
The next step: a clinical study with patients
With successful animal trials behind them, Implican is gearing up for the next milestone: its first clinical study in humans. This phase brings its own challenges. “The hardest part is ensuring the device is completely safe and reliable,” says Kooijman. “We need to prove that the materials are sterile, biocompatible and harmless.”
Despite the hurdles, the team is optimistic. “In animal tests, the rings performed exactly as intended, healing the wound beautifully,” Havenga says.
The goal is to begin a feasibility study with patients in 2025. “This is a pivotal moment,” Kooijman emphasizes. “It’s our chance to prove that the device isn’t just technically sound but genuinely improves healing. If it succeeds, we’ll be one step closer to making this technology widely available.”
Nextgen Ventures: a partner in innovation
In November 2022, Implican welcomed Nextgen Ventures as a lead investor. But their contribution went far beyond financial backing. “Of course, they brought funding to the table, but it’s about much more than that,” Kooijman explains. “They challenge our plans, offer constructive feedback and ask the tough questions that help us make smarter decisions.”
Nextgen doesn’t just stay behind the scenes – they’re actively involved in the day-to-day. “I have bi-weekly calls with Roel from Nextgen,” says Kooijman. “We cover everything, from which conferences are worth attending, to making connections with other startups. They’ve helped us refine investor presentations, offering input on an animation we created for potential backers.”
The stereotype of aggressive, cutthroat investors doesn’t apply here. “Nextgen isn’t about barking orders or pushing us into corners,” says Havenga. “They’re professional, supportive and focused on collaboration.”
Their involvement came at a critical moment when Implican was considering a larger convertible loan from Triade and NOM. Nextgen’s guidance and resources have since become an integral part of the company’s strategy. “Their kind of support is invaluable for expanding our network and attracting new interest in what we’re building,” adds Havenga.
A future full of promise: enthusiasm and validation
Implican’s future is looking bright. Trust in the solution is growing both inside and outside the company. “Last summer, I had 15 minutes to present our story at a conference to about a hundred Dutch gastrointestinal surgeons,” Klaas shares. “The response was fantastic – not just to the company and our approach, but also to the results.”
This enthusiasm from peers is crucial. “Ultimately, it’s the surgeons who decide whether our device gets adopted,” Klaas points out. “Patients often don’t even know they’ll need it.”
Feedback from usability studies backs this optimism. “Many surgeons see it as almost miraculous that these wounds heal at all,” Ivo explains. “When they hear our story and see how we align the tissue layers, it all clicks for them. It just makes sense.”
Redefining surgical standards with a personal mission
Klaas and Ivo have clear goals for Implican’s future. “We want to bring our device to market and prove its success,” says Ivo. “Not just in Western countries but worldwide, ensuring as many patients as possible have access to better outcomes.”
“If our technique truly proves superior, we hope to replace traditional staples,” Klaas adds. “That would set a new standard in surgery, but the results and real-world practice will have to confirm that.”
For Klaas, the frustration of recurring anastomotic leaks is a personal motivator. “You see the suffering it causes patients and it really hits you. It’s incredibly disheartening when a patient comes back with complications despite all your care. If Implican can help reduce those complications, that’s immensely rewarding.” Beyond that, he finds great satisfaction in entrepreneurship: “Building this company has been fantastic.”
Ivo’s drive comes from a broader perspective. “My motivation is about working toward a goal with real impact. At Implican, I get to collaborate with talented, driven people in a positive environment and contribute to something that could improve healthcare globally. That gives me the energy to keep pushing forward.”
Growth and a promising future
The Implican team has recently doubled in size, and soon two graduate students will also join the team to contribute to the ongoing developments. “We plan to expand further in the future, but that depends on our next funding round,” Ivo explains. “This round, planned as soon as first clinical feasibility results are in, will be crucial to scaling up and taking the next big steps.”
For Klaas and Ivo, the road ahead is both challenging and full of promise. “We’ve already accomplished a lot,” Klaas reflects. “But there’s still so much more potential to unlock.” While doing so, their vision remains clear: transforming anastomotic surgery not just for today’s patients, but for generations to come.
