Abstract
BackgroundTissue adhesives (TA) may be useful to strengthen colorectal anastomoses, thereby preventing anastomotic leakage (AL). Previous studies have identified cyanoacrylate (CA) TAs as the most promising colonic anastomotic sealants. This study investigates the protective effects of sealing colonic anastomoses with various CAs.Materials and methodsFifty-five Wistar rats underwent laparotomy and transection of the proximal colon. An anastomosis was created with 4 interrupted sutures followed by either application of Histoacryl Flexible, Omnex, Glubran 2, or no TA seal. An additional control group was included with a 12-suture anastomosis and no TA seal. After 7 days, the rats were sacrificed and scored for the presence of AL as the main outcome. Secondary outcomes were the occurrence of bowel obstruction, adhesions, and anastomotic bursting pressure. Histological evaluation was performed.ResultsThe highest AL rate was found in the Glubran 2 group (7/11), followed by the 4-sutures group without TA (5/11), and the Omnex group (5/11). Histoacryl Flexible showed the lowest AL rate (2/11). In the control group, only one rat showed signs of AL. Histologically, the highest influx of inflammatory cells was found in the 4-suture group without TA and for Omnex and Glubran 2. Histoacryl Flexible caused more mature collagen deposition when compared to the other TA groups.ConclusionsHistoacryl Flexible showed the lowest leakage rate compared to the other TA groups and to the 4-suture control group. Glubran 2 showed the highest AL rate and a high inflammatory response. Histoacryl Flexible was associated with the presence of more mature collagen and seems to promote anastomotic healing.
Highlights
The idea of sealing an anastomosis externally with a tissue adhesive is gaining popularity and has been linked to promising results [1]
All analyses were performed using IBM SPSS Statistics, version 21.0 for Mac (IBM SPSS, USA). Both in the 4-suture non-Tissue adhesives (TA) group and in the Glubran 2 group, one rat died prior to completion of the follow-up period due to fecal peritonitis caused by anastomotic leakage (AL)
In the 12-suture control group, AL occurred in one rat, associated with an abscess score of 1
Summary
The idea of sealing an anastomosis externally with a tissue adhesive is gaining popularity and has been linked to promising results [1]. The benefit of such a technique is that a surgeon can create an anastomosis in a conventional manner using sutures or staples and perform an intra-operative anastomotic patency test, before applying an extra layer of protection on the serosal surface of the anastomosed colon. CA is a type of chemical polymer, known as Bsuperglue.^ Several experimental studies have been performed using CA glues to prevent AL, yielding ambiguous results [1, 2].
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