Abstract
PurposeProtecting the anastomotic integrity using suture or staple line reinforcement remains an important goal for ongoing research. The present comprehensive study aims to establish the effects of fibrin glue on the early phase of anastomotic healing in the rat intestine.MethodsOne hundred and eight young adult male Wistar rats underwent resection and anastomosis of both the ileum and colon. In half, fibrin glue was applied around the anastomoses. Parameters for repair included wound strength, both bursting pressure and breaking strength at days 1, 3, and 5 after operation; hydroxyproline content; and histology, the latter also after 7 days.ResultsA transient colonic ileus was observed in the experimental group. Anastomotic breaking strength was always similar in both the control and fibrin glue groups. Anastomotic bursting pressures remained low at days 1 and 3, without any differences between the groups. In both groups, the bursting pressure increased sharply (p < 0.001) between days 3 and 5. At day 5, the bursting pressure in the fibrin glue group remained below than that in the controls, although only significantly (p = 0.0138) so in the ileum. At day 5, but not at day 7, the wounds in the fibrin glue group contained less collagen. Other aspects of microscopic wound architecture appeared to be the same.ConclusionsThere is no justification for using fibrin glue on patent anastomoses constructed under low-risk conditions. Its potential benefit under conditions where chances for anastomotic leakage are enhanced needs further investigation.
Highlights
Anastomotic dehiscence is the most feared and potentially devastating complication after gastrointestinal surgery
One hundred and eight male Wistar rats, weighing 250– 295 g (Harlan BV, Horst, The Netherlands), were housed two per cage and accustomed to laboratory conditions for 5 days before the start of the experiment. They were randomly divided over the control group (n054) or the group in which fibrin glue was applied around the anastomoses (n0 54)
Three animals in the fibrin glue group did not survive surgery, while one animal in the control group died during the first night after operation
Summary
Anastomotic dehiscence is the most feared and potentially devastating complication after gastrointestinal surgery. A leaking anastomosis is associated with increased morbidity and considerable mortality [1, 2]. Protecting the anastomotic integrity and finding ways to minimize, postpone, or prevent the consequences of leakage, remain as the important goals of ongoing research. It seems logical to apply some kind of seal around the anastomosis to prevent leakage. It has been emphasized again that the potential benefits of such suture or staple line reinforcement need investigation [3]. In this respect, a possible role for tissue glues should not be overlooked
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