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Tomasicchio G, Martines G, Tartaglia N, Buonfantino M, Restini E, Carlucci B, Giove C, Dezi A, Ranieri C, Logrieco G, Vincenti L, Ambrosi A, Altomare DF, De Fazio M, Picciariello A. Suture reinforcement using a modified cyanoacrylate glue to prevent anastomotic leak in colorectal surgery: a prospective multicentre randomized trial : The Rectal Anastomotic seaL (ReAL) trial. Tech Coloproctol 2024; 28:95. [PMID: 39103661 DOI: 10.1007/s10151-024-02967-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/22/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Anastomotic leakage (AL) is the most frequent life-threating complication following colorectal surgery. Several attempts have been made to prevent AL. This prospective, randomized, multicentre trial aimed to evaluate the safety and efficacy of nebulised modified cyanoacrylate in preventing AL after rectal surgery. METHODS Patients submitted to colorectal surgery for carcinoma of the high-medium rectum across five high-volume centres between June 2021 and January 2023 entered the study and were randomized into group A (anastomotic reinforcement with cyanoacrylate) and group B (no reinforcement) and followed up for 30 days. Anastomotic reinforcement was performed via nebulisation of 1 mL of a modified cyanoacrylate glue. Preoperative features and intraoperative and postoperative results were recorded and compared. The study was registered at ClinicalTrials.gov (ID number NCT03941938). RESULTS Out of 152 patients, 133 (control group, n = 72; cyanoacrylate group, n = 61) completed the follow-up. ALs were detected in nine patients (12.5%) in the control group (four grade B and five grade C) and in four patients (6.6%), in the cyanoacrylate group (three grade B and one grade C); however, despite this trend, the differences were not statistically significant (p = 0.36). However, Clavien-Dindo complications grade > 2 were significantly higher in the control group (12.5% vs. 3.3%, p = 0.04). No adverse effects related to the glue application were reported. CONCLUSION The role of modified cyanoacrylate application in AL prevention remains unclear. However its use to seal colorectal anastomoses is safe and could help to reduce severe postoperative complications.
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Affiliation(s)
- G Tomasicchio
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino", University of Bari Aldo Moro, Bari, Italy.
| | - G Martines
- Azienda Ospedaliero Universitaria Policlinico, University of Bari, Piazza G Cesare, 11, 70124, Bari, Italy
| | - N Tartaglia
- Department of Medical and Surgical Sciences, DSMC, University of Foggia, Foggia, Italy
| | - M Buonfantino
- General Surgery Unit, Hospital "San Paolo", Bari, Italy
| | - E Restini
- General Surgery Unit, Hospital "L. Bonomo", Andria, Italy
| | - B Carlucci
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino", University of Bari Aldo Moro, Bari, Italy
| | - C Giove
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino", University of Bari Aldo Moro, Bari, Italy
| | - A Dezi
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino", University of Bari Aldo Moro, Bari, Italy
| | - C Ranieri
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino", University of Bari Aldo Moro, Bari, Italy
| | - G Logrieco
- General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - L Vincenti
- General Surgery Unit, IRCCS "Saverio De Bellis", Castellana Grotte, Italy
| | - A Ambrosi
- Department of Medical and Surgical Sciences, DSMC, University of Foggia, Foggia, Italy
| | - D F Altomare
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino", University of Bari Aldo Moro, Bari, Italy
| | - M De Fazio
- Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino", University of Bari Aldo Moro, Bari, Italy
| | - A Picciariello
- Department of Experimental Medicine, University of Salento, Lecce, Italy
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Gené-Škrabec C, Cremades M, Fernández-Pujol A, Cortinovis S, Corral J, Julián JF, Parés D. Clinical results after external reinforcement of colorectal anastomosis: a systematic review. Int J Surg 2023; 109:4322-4332. [PMID: 37707516 PMCID: PMC10720808 DOI: 10.1097/js9.0000000000000747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of this review is to describe and assess the existing methods to cover colorectal anastomoses with biomaterials and their clinical impact in reducing anastomotic leakage (AL). SUMMARY BACKGROUND DATA The most serious complication in colorectal surgery is AL. Despite improvements in its diagnosis and management, AL remains an unresolved issue. To prevent its appearance and clinical consequences, different external reinforcement techniques with synthetic or biomaterials have been described. METHODS A systematic review search of the available literature until June 2022 was performed, looking for all literature regarding external reinforcement of colonic or colorectal anastomoses. After the review process, a classification of materials was proposed into solid and liquid materials, and an assessment of their clinical impact was performed. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA and AMSTAR Guidelines 11,12 . RESULTS Ninety-seven articles that fulfilled inclusion criteria, were identified and revised. Overall, 18 of the selected articles focused on human clinical trials and 79 on animal models. Only fibrin sealants, collagen patches, and omentoplasty have shown positive results in humans. CONCLUSIONS Fibrin sealants, collagen patches, and omentoplasty are, so far, the most studied biomaterials. However, further studies are required to confirm these findings before definite recommendations can be made.
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Affiliation(s)
- Clara Gené-Škrabec
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - Manel Cremades
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | | | - Sara Cortinovis
- Department of General Surgery, ASUGI Cattinara, Università degli studi di Trieste, Trieste, Italy
| | - Javier Corral
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - Joan-F Julián
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
| | - David Parés
- Department of General Surgery, Hospital Universitari Germans Trias i Pujol, School of Medicine, Universitat Autònoma de Barcelona, Institut de Recerca Germans Trias i Pujol – IGTP, Barcelona, Spain
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Ponce-Herrera D, Ramírez-Ochoa S, Flores-Álvarez E, Gómez-Arambulo R, Nava-Román JM, Méndez-Esparza AG, Cervantes-Guevara G, González-Ojeda A, Fuentes-Orozco C, González-Valencia CM, Ambriz-Alarcón MA, Meugniot-García H, Rubio-Mora BR, Cervantes-Pérez E. Colonic Anastomoses Reinforced With Ethyl-2-Cyanoacrylate Compared With Polydioxanone Sutures Alone in Fecal Peritonitis: An Experimental Study in Wistar Rats. Cureus 2023; 15:e49516. [PMID: 38156173 PMCID: PMC10752756 DOI: 10.7759/cureus.49516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION The use of tissue adhesives has been proposed as an anastomosis reinforcement; however, their efficacy has not been evaluated in a contaminated environment. The objective of this study was to determine if the use of sutures reinforced with ethyl-2-cyanoacrylate for colonic anastomoses in the presence of fecal peritonitis, in a murine animal model, decreases the frequency of dehiscence. METHODS Wistar rats were used. Fecal peritonitis was established until reaching 18 hours of evolution. Then, resection and anastomosis of the colon were performed with only polydioxanone (PDS) sutures in the control group and reinforcement with ethyl-2-cyanoacrylate in the experimental group. The dehiscence frequency and burst pressure were evaluated six days after the anastomosis was performed. RESULTS We included 30 Wistar rats, all males, with a median age of five months and an average weight of 350.43 g. Anastomotic dehiscence was observed in 53.33% of the control group, in contrast with 13.33% of the experimental group (p = 0.020). There was no significant difference in burst pressure between the two groups. CONCLUSION The use of ethyl-2-cyanoacrylate, in an experimental murine animal model, as reinforcement in colonic anastomoses in the presence of fecal peritonitis decreases the frequency of anastomotic dehiscence, although it does not increase resistance to burst pressure.
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Affiliation(s)
- David Ponce-Herrera
- Department of Surgical Oncology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
| | - Sol Ramírez-Ochoa
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
| | - Efrén Flores-Álvarez
- Department of Surgical Oncology, Centenario Hospital Miguel Hidalgo, Aguascalientes, MEX
| | | | - José M Nava-Román
- Department of Surgery, ISSEA Hospital General Tercer Milenio, Aguascalientes, MEX
| | | | - Gabino Cervantes-Guevara
- Department of Welfare and Sustainable Development, Centro Universitario del Norte, Universidad de Guadalajara, Guadalajara, MEX
- Department of Gastroenterology, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
| | - Alejandro González-Ojeda
- Biomedical Research Unit 02, Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social, Guadalajara, MEX
| | - Clotilde Fuentes-Orozco
- Biomedical Research Unit 02, Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social, Guadalajara, MEX
| | | | - Mauricio A Ambriz-Alarcón
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
| | - Héctor Meugniot-García
- Department of Internal Medicine, Centro Médico Nacional de Occidente Instituto Mexicano del Seguro Social, Guadalajara, MEX
| | - Brian R Rubio-Mora
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
| | - Enrique Cervantes-Pérez
- Department of Internal Medicine, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, MEX
- Tlajomulco University Center, Universidad de Guadalajara, Tlajomulco de Zuñiga, MEX
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Abstract
Leaks from anastomoses can be a serious complication of any gastrointestinal resection. Leaks lead to increased morbidity, delayed postoperative recovery, and potential delays in adjuvant treatment in cancer cases. Prevention of anastomotic leak has been an area of ongoing research for decades. Methods of assessing bowel perfusion have been developed that may provide forewarning of anastomotic compromise. Physical reinforcement of the anastomosis with buttressing material is an available method employed with the goal of preventing leaks. Liquid-based sealants have also been explored. Lastly, interactions between the gut microbiome and anastomotic healing have been investigated as a mean of manipulating the microenvironment to reduce leak rates. Though no single technology has been successful in eliminating leaks, an understanding of these developing fields will be important for all surgeons who operate on the gastrointestinal tract.
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Affiliation(s)
- Abhineet Uppal
- Division of Colorectal Surgery, Department of Surgery, University of California at Irvine Medical Center, Orange, California
| | - Alessio Pigazzi
- Division of Colorectal Surgery, Department of Surgery, University of California at Irvine Medical Center, Orange, California
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Christodoulidis G, Samara AA, Floros T, Karakantas KS, Zotos PA, Koutras A, Tepetes K. The Contribution of a Collagen Patch Coated With Fibrin Glue in Sealing Upper Gastrointestinal Defects: An Experimental Study. In Vivo 2021; 35:2697-2702. [PMID: 34410958 DOI: 10.21873/invivo.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM We aimed to evaluate the safety and efficacy of sealing primary upper gastrointestinal (GI) perforations with a collagen patch coated with fibrin glue (Tachosil®). MATERIALS AND METHODS Thirty New Zealand rabbits were used in this study. An iatrogenic gastric perforation was created, and primary repair was performed on the control group. Tachosil®, without suturing the deficit, was used in the intervention group. RESULTS Leakage was observed in 3 (20%) and 2 rabbits (13.3%) in the control and intervention group, respectively; however, the difference was not statistically significant (p=0.62). Moreover, adhesions formed in 10/15 and all rabbits in the intervention and control group, respectively (p=0.014); however, based on the Zuhlke adhesion's classification, there was no statistically significant difference between the two groups. CONCLUSION A collagen patch coated with fibrin glue is not a replacement but can be considered a safe option for the reinforcement of suturing, preventing leakages in the upper GI tract.
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Affiliation(s)
| | - Athina A Samara
- Laboratory of Experimental Surgery, University of Thessaly, Larissa, Greece;
| | - Theodoros Floros
- Laboratory of Experimental Surgery, University of Thessaly, Larissa, Greece
| | | | | | - Antonios Koutras
- 1 Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Slezak P, Klang A, Ferguson J, Monforte X, Schmidt P, Bauder B, Url A, Osuchowski M, Redl H, Spazierer D, Gulle H. Tissue reactions to polyethylene glycol and glutaraldehyde-based surgical sealants in a rabbit aorta model. J Biomater Appl 2020; 34:1330-1340. [PMID: 31959032 PMCID: PMC7088439 DOI: 10.1177/0885328219900078] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul Slezak
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology in AUVA Research Center, Vienna, Austria
| | - Andrea Klang
- University of Veterinary Medicine, Institute of Pathology, Vienna, Austria
| | - James Ferguson
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology in AUVA Research Center, Vienna, Austria
| | - Xavier Monforte
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology in AUVA Research Center, Vienna, Austria
| | - Peter Schmidt
- University of Veterinary Medicine, Institute of Pathology, Vienna, Austria
| | - Barbara Bauder
- University of Veterinary Medicine, Institute of Pathology, Vienna, Austria
| | - Angelika Url
- University of Veterinary Medicine, Institute of Pathology, Vienna, Austria
| | - Marcin Osuchowski
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology in AUVA Research Center, Vienna, Austria
| | - Heinz Redl
- Ludwig Boltzmann Institute for Clinical and Experimental Traumatology in AUVA Research Center, Vienna, Austria
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Chen M, Cao J, Huang D, Zhang B, Pan L, Zhang Z, Wang Z, Ye Y, Xiu D, Li D, Cai X. End-to-end intestinal anastomosis using a novel biodegradable stent for laparoscopic colonic surgery: a multicenter study. Surg Today 2019; 49:1003-1012. [PMID: 31256255 DOI: 10.1007/s00595-019-01841-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 06/02/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Our animal studies have demonstrated the safety and feasibility of end-to-end intestinal anastomosis using a stent for laparoscopic colonic surgery. Therefore, we designed a non-inferiority trial to investigate the outcomes of stent anastomosis (SA) vs. those of conventional hand-sewn anastomosis (CA). METHODS A multicenter randomized controlled trial was conducted between December, 2016 and April, 2018. The primary outcome was the healing condition of the anastomoses, evaluated by endoscopy 6 months postoperatively. The secondary outcomes were the anastomotic completion time, anastomotic leak, intestinal obstruction, peritoneal effusion, and bleeding. Quality of life (QOL) was evaluated by questionnaires. RESULTS The subjects of this study were 60 patients, randomly divided into a SA group (n = 30) and a CA group (n = 30). There were no differences in anastomotic healing conditions (P = 1.00). The stent procedure was associated with a significantly shorter anastomosis time than the hand-sewn anastomosis (13.517 ± 4.281 vs. 20.333 ± 2.998 min, respectively; P < 0.001). There were no significant differences in anastomotic leakage, intestinal obstruction, peritoneal effusion, or bleeding between the groups. Questionnaires revealed almost no discrepancy between baseline QOL scores and those assessed 2, 4, 8, 12, and 24 weeks postoperatively in either group. CONCLUSIONS Intestinal anastomosis with a stent is a non-inferior strategy for laparoscopic colonic surgery, which requires less time for the anastomosis.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Diyu Huang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Long Pan
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China
| | - Zhongtao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, 100032, China
| | - Zhenjun Wang
- Department of Anorectal Surgery, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Yingjiang Ye
- Department of Gastrointestinal Surgery, Peking University People's Hospital, Beijing, 100032, China
| | - Dianrong Xiu
- Department of General Surgery, Peking University Third Hospital, Beijing, 100089, China
| | - Dechuan Li
- Department of Colorectal Surgery, Zhejiang Cancer Hospital, Hangzhou, 310011, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, No.3 East Qingchun Road, Hangzhou, 310016, China.
- Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China.
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Histologic changes in early colonic anastomotic healing using autologous platelet-rich fibrin matrix. Eur Surg 2019. [DOI: 10.1007/s10353-019-0578-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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9
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Trotter J, Onos L, McNaught C, Peter M, Gatt M, Maude K, MacFie J. The use of a novel adhesive tissue patch as an aid to anastomotic healing. Ann R Coll Surg Engl 2018; 100:230-234. [PMID: 29484939 PMCID: PMC5930107 DOI: 10.1308/rcsann.2018.0003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction One of the most feared complications of colorectal surgery is anastomotic leak. Numerous techniques have been studied in the hope of decreasing leakage. This study was designed to assess the handling characteristics of a novel adhesive tissue patch (TissuePatch™; Tissuemed, Leeds, UK) applied to colorectal anastomoses in a pilot study. This was with a view to assessing its potential role in aiding anastomotic healing in subsequent trials. Methods A patch was applied to colorectal anastomoses after the surgeon had completed the anastomosis and prior to abdominal closure. Handling characteristics and patient outcomes were recorded prospectively. Results Nine patients were recruited before the study was prematurely terminated. In one patient, the patch fell off and in another patient, the surgeon omitted to apply it. Six patients had significant postoperative problems (1 confirmed leak necessitating return to theatre and excision anastomosis, 3 suspicious of leak on computed tomography delaying discharge, 2 perianastomotic collections). One patient had an uneventful recovery. Conclusions Although the handling characteristics of this novel tissue patch were deemed satisfactory, it appears that wrapping a colorectal anastomosis with an adhesive hydrophilic patch has significant deleterious effects on anastomotic healing. This could be a consequence of the creation of a microenvironment between the patch and the anastomosis that impairs healing. Further research is required to better understand the mechanisms involved. At present, the use of such patches on colorectal anastomoses should be discouraged outside the confines of a well monitored trial.
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Affiliation(s)
- J Trotter
- York Teaching Hospital NHS Foundation Trust, UK
| | - L Onos
- York Teaching Hospital NHS Foundation Trust, UK
| | - C McNaught
- York Teaching Hospital NHS Foundation Trust, UK
| | - M Peter
- York Teaching Hospital NHS Foundation Trust, UK
| | - M Gatt
- York Teaching Hospital NHS Foundation Trust, UK
| | - K Maude
- York Teaching Hospital NHS Foundation Trust, UK
| | - J MacFie
- York Teaching Hospital NHS Foundation Trust, UK
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10
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Pericardium matrix buttressing hinders the stapled bronchial stump healing. J Surg Res 2016; 201:286-92. [DOI: 10.1016/j.jss.2015.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 11/05/2015] [Accepted: 11/11/2015] [Indexed: 12/15/2022]
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Vakalopoulos KA, Wu Z, Kroese LF, van der Horst PH, Lam KH, Dodou D, Jeekel JJ, Lange JF. Clinical, mechanical, and immunohistopathological effects of tissue adhesives on the colon: An in-vivo study. J Biomed Mater Res B Appl Biomater 2016; 105:846-854. [PMID: 26804979 DOI: 10.1002/jbm.b.33621] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/06/2015] [Accepted: 01/03/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Tissue adhesives may be useful for sealing bowel anastomoses by preventing anastomotic leakage. Prior to clinical implementation, an in-depth analysis of the clinical and immunohistopathological effects of tissue adhesives on the target tissue and of the mechanical strength of the adhesive bond in an in vivo model is needed. MATERIALS AND METHODS In 84 rats, two bowel segments were glued using one of the following tissue adhesive: Bioglue, Gelatin-resorcinol-formaldehyde (GRF), Glubran 2, Histoacryl Flex, Omnex, Duraseal Xact, or Tissucol. Rats were followed for 7 or 28 days. Endpoints were clinical complication rate, mechanical strength, and immunohistopathological reactions. RESULTS Of the seven tissue adhesives, GRF and Bioglue showed the highest rates of bowel wall destruction and ileus and the most severe immunohistopathological tissue reactions at 7 and 28 days. Cyanoacrylates (Histoacryl Flex, Omnex, Glubran 2) showed high mechanical strength and mild immunohistopathological reactions at 7 and 28 days. Duraseal Xact and Tissucol were the most inert tissue adhesives, but exhibited low mechanical strength. At 28 days, mechanical strength was significantly correlated to CD8, CD68, and Ki67 cell counts. CONCLUSION Based on the clinical and immunohistopathological outcomes, GRF and Bioglue were found to be the least suitable tissue adhesives for colonic use. Duraseal Xact and Tissucol were inert but also showed low mechanical strength. Cyanoacrylates exhibited mild clinical and immunohistopathological effects while maintaining high strength, which makes them promising as colonic sealants. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 105B: 846-854, 2017.
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Affiliation(s)
| | - Zhouqiao Wu
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Leonard F Kroese
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Paul H van der Horst
- Department of Gynaecology and Obstetrics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - King H Lam
- Department of Pathology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Dimitra Dodou
- Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | - Johannes J Jeekel
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johan F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
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12
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Bosmans JWAM, Moossdorff M, Al-Taher M, van Beek L, Derikx JPM, Bouvy ND. International consensus statement regarding the use of animal models for research on anastomoses in the lower gastrointestinal tract. Int J Colorectal Dis 2016; 31:1021-1030. [PMID: 26960997 PMCID: PMC4834109 DOI: 10.1007/s00384-016-2550-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE This project aimed to reach consensus on the most appropriate animal models and outcome measures in research on anastomoses in the lower gastrointestinal tract (GIT). The physiology of anastomotic healing remains an important research topic in gastrointestinal surgery. Recent results from experimental studies are limited with regard to comparability and clinical translation. METHODS PubMed and EMBASE were searched for experimental studies investigating anastomotic healing in the lower GIT published between January 1, 2000 and December 31, 2014 to assess currently used models. All corresponding authors were invited for a Delphi-based analysis that consisted of two online survey rounds followed by a final online recommendation survey to reach consensus on the discussed topics. RESULTS Two hundred seventy-seven original articles were retrieved and 167 articles were included in the systematic review. Mice, rats, rabbits, pigs, and dogs are currently being used as animal models, with a large variety in surgical techniques and outcome measures. Forty-four corresponding authors participated in the Delphi analysis. In the first two rounds, 39/44 and 35/39 participants completed the survey. In the final meeting, 35 experts reached consensus on 76/122 items in six categories. Mouse, rat, and pig are considered appropriate animal models; rabbit and dog should be abandoned in research regarding bowel anastomoses. ARRIVE guidelines should be followed more strictly. CONCLUSIONS Consensus was reached on several recommendations for the use of animal models and outcome measurements in research on anastomoses of the lower GIT. Future research should take these suggestions into account to facilitate comparison and clinical translation of results.
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Affiliation(s)
- Joanna W A M Bosmans
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Martine Moossdorff
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Mahdi Al-Taher
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Lotte van Beek
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
| | - Joep P M Derikx
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Pediatric Surgical Center of Amsterdam, Emma Children's Hospital University Medical Centre and VU Medical Centre, Amsterdam, The Netherlands
| | - Nicole D Bouvy
- Department of General Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202, AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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Eryılmaz A, Demirci B, Gunel C, Kacar Doger F, Yukselen O, Kurt Omurlu I, Basal Y, Agdas F, Basak S. Can tissue adhesives and platelet-rich plasma prevent pharyngocutaneous fistula formation? Auris Nasus Larynx 2015; 43:62-7. [PMID: 26229017 DOI: 10.1016/j.anl.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 05/05/2015] [Accepted: 06/22/2015] [Indexed: 02/06/2023]
Abstract
OBJECTIVE One of the frequently encountered disorders of wound healing following laryngectomy is pharyngocutaneous fistula. However, although studies have been performed with the aim of prevention of pharyngocutaneous fistulae, there are very few studies with tissue adhesives and platelet-rich plasma. In this study, our aim was to investigate the histopathologic changes in wound healing caused by various tissue adhesives and platelet-rich plasma, together with their effects on prevention of pharyngocutaneous fistula. METHODS 40 male rats were randomly divided into five groups: control, platelet-rich plasma, fibrin tissue adhesive, protein-based albumin glutaraldehyde and synthetic tissue adhesive groups. The pharyngotomy procedure was performed and was sutured. Except the control group, tissue adhesives and platelet-rich plasma were applied. Then, the skin was sutured. On the seventh day, the rats were sacrificed. The skin was opened and pharyngotomy site was assessed in terms of fistulae. The pharyngeal suture line was evaluated histopathologically by using Ehrlich Hunt scale. RESULTS Inflammatory infiltration was found to be higher in "platelet-rich plasma" group than "fibrin tissue adhesive" and "synthetic tissue adhesive" groups. The fibroblastic activity of "platelet-rich plasma", "fibrin tissue adhesive" and "protein-based albumin glutaraldehyde" groups was higher than the control group. The positive changes created by platelet-rich plasma and fibrin tissue adhesive at the histopathologic level were found together with no detected fistula. Among the study groups, there was no statistical difference for pharyngeal fistula development. This result may be obtained by the small number of animal experiments. CONCLUSION These results shed light on the suggestion that platelet-rich plasma and fibrin tissue adhesive can be used in clinical studies to prevent pharyngocutaneous fistula.
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Affiliation(s)
- Aylin Eryılmaz
- Department of Otorhinolaryngology Head and Neck Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey.
| | - Buket Demirci
- Department of Medical Pharmacology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ceren Gunel
- Department of Otorhinolaryngology Head and Neck Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Firuzan Kacar Doger
- Department of Medical Pathology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Ozden Yukselen
- Pathology Department, Aydin State Hospital, Aydın, Turkey
| | - Imran Kurt Omurlu
- Department of Biostatistics, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Yesim Basal
- Department of Otorhinolaryngology Head and Neck Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Fatih Agdas
- Department of Otorhinolaryngology Head and Neck Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sema Basak
- Department of Otorhinolaryngology Head and Neck Surgery, Adnan Menderes University School of Medicine, Aydın, Turkey
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Scognamiglio F, Travan A, Rustighi I, Tarchi P, Palmisano S, Marsich E, Borgogna M, Donati I, de Manzini N, Paoletti S. Adhesive and sealant interfaces for general surgery applications. J Biomed Mater Res B Appl Biomater 2015; 104:626-39. [PMID: 25891348 DOI: 10.1002/jbm.b.33409] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 01/15/2015] [Accepted: 02/26/2015] [Indexed: 12/16/2022]
Abstract
The main functions of biological adhesives and sealants are to repair injured tissues, reinforce surgical wounds, or even replace common suturing techniques. In general surgery, adhesives must match several requirements taking into account clinical needs, biological effects, and material features; these requirements can be fulfilled by specific polymers. Natural or synthetic polymeric materials can be employed to generate three-dimensional networks that physically or chemically bind to the target tissues and act as hemostats, sealants, or adhesives. Among them, fibrin, gelatin, dextran, chitosan, cyanoacrylates, polyethylene glycol, and polyurethanes are the most important components of these interfaces; various aspects regarding their adhesion mechanisms, mechanical performance, and resistance to body fluids should be taken into account to choose the most suitable formulation for the target application. This review aims to describe the main adhesives and sealant materials for general surgery applications developed in the past decades and to highlight the most important aspects for the development of future formulations.
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Affiliation(s)
| | - Andrea Travan
- Department of Life Sciences, University of Trieste, Italy
| | | | - Paola Tarchi
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Silvia Palmisano
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | - Eleonora Marsich
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
| | | | - Ivan Donati
- Department of Life Sciences, University of Trieste, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, Internal Medicine Clinic, University of Trieste, Italy
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Nordentoft T, Pommergaard HC, Rosenberg J, Achiam MP. Fibrin glue does not improve healing of gastrointestinal anastomoses: a systematic review. Eur Surg Res 2014; 54:1-13. [PMID: 25247310 DOI: 10.1159/000366418] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 08/04/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND/AIM Anastomotic leakage remains a frequent and serious complication in gastrointestinal surgery. In order to reduce its incidence, several clinical and experimental studies on anastomotic sealing have been performed. In a number of these studies, the sealing material has been fibrin glue (FG), and the results in individual studies have been varying. The positive effect of anastomotic sealing with FG might be due to the mechanical/physical properties, the increased healing of the anastomoses or both. The aim of this systematic review was to evaluate the existing evidence on the healing effects of FG on gastrointestinal anastomoses. METHODS PubMed, EMBASE and the Cochrane databases were searched for studies evaluating the healing process of gastrointestinal anastomoses after any kind of FG application. The search period was from 1953 to December 2013. RESULTS Twenty-eight studies were included in the qualitative synthesis. These studies were all experimental studies, since no human studies used histological or biochemical evaluation of healing. In 7 of the 28 studies, a positive effect of FG on healing was found, while 8 studies reported a negative effect and 11 studies found no effect. Furthermore, 2 studies reported unclear results. The difference in the study outcome was independent of the study design and the type of FG used. CONCLUSION In the available studies, FG did not consistently have a positive influence on the healing of gastrointestinal anastomoses. It is consequently plausible that the positive effect of FG sealing of gastrointestinal anastomoses, if there is any, may be due to a mechanical sealing effect rather than due to improved healing per se.
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Affiliation(s)
- Tyge Nordentoft
- Department of Gastrointestinal Surgery 360, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
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Prevention of leakage by sealing colon anastomosis: experimental study in a mouse model. J Surg Res 2013; 184:819-24. [PMID: 23764314 DOI: 10.1016/j.jss.2013.04.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 03/22/2013] [Accepted: 04/05/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND In colorectal surgery, anastomotic leakage (AL) is the most significant complication. Sealants applied around the colon anastomosis may help prevent AL by giving the anastomosis time to heal by mechanically supporting the anastomosis and preventing bacteria leaking into the peritoneal cavity. The aim of this study is to compare commercially available sealants on their efficacy of preventing leakage in a validated mouse model for AL. METHODS Six sealants (Evicel, Omnex, VascuSeal, PleuraSeal, BioGlue, and Colle Chirurgicale Cardial) were applied around an anastomosis constructed with five interrupted sutures in mice, and compared with a control group without sealant. Outcome measures were AL, anastomotic bursting pressure, and death. RESULTS In the control group there was a 40% death rate with a 50% rate of AL. None of the sealants were able to diminish the rate of AL. Furthermore, use of the majority of sealants resulted in failure to thrive, increased rates of ileus, and higher mortality rates. CONCLUSIONS If sealing of a colorectal anastomosis could achieve a reduction of incidence of clinical AL, this would be a promising tool for prevention of leakage in colorectal surgery. In this study, we found no evidence that sealants reduce leakage rates in a mouse model for AL. However, the negative results of this study make us emphasize the need of systemic research, investigating histologic tissue reaction of the bowel to different sealants, the capacity of sealants to form a watertight barrier, their time of degradation, and finally their results in large animal models for AL.
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The effect of fibrin glue on the intensity of colonic anastomosis in the presence and absence of peritonitis: an experimental randomized controlled trial on rats. ISRN SURGERY 2013; 2013:521413. [PMID: 23401799 PMCID: PMC3563166 DOI: 10.1155/2013/521413] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Accepted: 12/30/2012] [Indexed: 01/01/2023]
Abstract
Aim. Anastomotic leakage after colon anastomosis is the most frequent and most feared complication with its highest mortality rate. In this study, we aimed to expose the impact of performing fibrin glue on sutured colocolic anastomosis, in the presence of experimental peritonitis, on anastomosis safety. Method. In this experimental study, the rats were divided into two groups as control group (Groups 1 and 3) and experimental group (Groups 2 and 4). They were also divided as clean abdomen (Groups 1 and 2) and infected abdomen (3 and 4) groups. Full-thickness incisions were made on the proximal colon of both groups of rats. The control group's anastomoses were conducted only with sutures, whereas in experimental group, fibrin glue was applied over the sutures. The samples were taken on the 10th day. Results. Highest values for average levels of hydroxyproline in the tissues and anastomotic bursting pressures were detected when fibrin glue was applied on sutured anastomosis in clean abdomen. In the histopathological staging performed in line with Ehrlich-Hunt model, lowest values were detected during the presence of peritonitis. Conclusion. As a result, it has been established that the use of fibrin glue over sutured colocolic anastomosis, both in clean abdomen and in the presence of peritonitis, had increased anastomosis safety.
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Vakalopoulos KA, Daams F, Wu Z, Timmermans L, Jeekel JJ, Kleinrensink GJ, van der Ham A, Lange JF. Tissue adhesives in gastrointestinal anastomosis: a systematic review. J Surg Res 2013; 180:290-300. [PMID: 23384970 DOI: 10.1016/j.jss.2012.12.043] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 11/24/2012] [Accepted: 12/20/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Anastomotic leakage in gastrointestinal (GI) surgery remains a major problem. Although numerous studies have been undertaken on the role of tissue adhesives as GI anastomotic sealants, no clear overview has been presented. This systematic review aims to provide a clear overview of recent experimental and clinical research on the sealing of different levels of GI anastomosis with tissue adhesives. METHODS We searched MEDLINE and Embase databases for clinical and experimental articles published after 2000. We included articles only if these addressed a tissue adhesive applied around a GI anastomosis to prevent anastomotic leakage or decrease leakage-related complications. We categorized results according to level of anastomosis, category of tissue adhesive, and level of evidence. RESULTS We included 48 studies: three on esophageal anastomosis, 13 on gastric anastomosis, four on pancreatic anastomosis, eight on small intestinal anastomosis, and 20 on colorectal anastomosis; 15 of the studies were on humans. CONCLUSIONS Research on ileal and gastric/bariatric anastomosis reveals promising results for fibrin glue sealing for specific clinical indications. Sealing of pancreatico-enteric anastomosis does not seem to be useful for high-risk patients; however, research in this field is limited. Ileal anastomotic sealing was promising in every included study, and calls for clinical evaluation. For colorectal anastomoses, sealing with fibrin glue sealing seems to have more positive results than with cyanoacrylate. Further research should concentrate on the clinical evaluation of promising experimental results as well as on new types of tissue adhesives. This research field would benefit from a systematic experimental approach with comparable methodology.
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Abstract
PURPOSE Colon anastomotic leakage remains both a frequent and serious complication in gastrointestinal surgery. External coating of colonic anastomoses has been proposed as a means to lower the rate of this complication. The aim of this review was to evaluate existing studies on external coating of colonic anastomoses. METHODS CINAHL, EMBASE, and PubMed were searched up to September 2011 to identify studies evaluating external coating of colonic anastomoses. RESULTS Forty studies have evaluated 20 different coating materials, of which only fibrin sealant, omental pedicle graft, and hyaluronic acid/carboxymethylcellulose have been used in humans. Fibrin sealant has shown positive, however not significant, results. Omental pedicle graft can be used safely, yet without beneficial effects, whereas hyaluronic acid/carboxymethylcellulose should be avoided due to increased complications. The remaining coating materials have solely been evaluated in experimental animals with many contradictory and few positive results. CONCLUSIONS External coating of colonic anastomoses has yet failed to show convincing results. Randomized clinical trials and high-quality experimental studies are warranted to determine the role of fibrin sealant, omental pedicle graft, and other coating materials for prevention of colon anastomotic leakage.
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Current World Literature. Curr Opin Rheumatol 2012; 24:119-22. [DOI: 10.1097/bor.0b013e32834f0d5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cueto J, Barrientos T, Rodríguez E, Del Moral P. A new biodegradable adhesive for protection of intestinal anastomoses. Preliminary communication. Arch Med Res 2011; 42:475-81. [PMID: 21939702 DOI: 10.1016/j.arcmed.2011.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 08/12/2011] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Anastomotic leaks continue to be a devastating complication for patients and surgeons worldwide. The few surgical adhesives available to date have not achieved the desired clinical results. The purpose of this experimental study was to determine if Pebisut® applied to intestinal suture lines provides increased resistance and protection during the critical days of healing. METHODS Intestinal lesions were caused in rats and dogs and a new biodegradable adhesive (Pebisut®) (patent granted in the European Union 07808494.4-1219, 01.12.2010, in Mexico P.C.T./MX/a/2009/001737, 16.02.2009, pending in the U.S.P.T.O. 60/762,136, 26.01.2006) was applied to compare the resistance of suture lines using bursting pressures and histologically. RESULTS Under acute and chronic conditions, Pebisut® strengthened and made the suture lines more resistant, while histologically penetrating and sealing them. The adhesive disappears within 2-3 weeks and is well tolerated by the intestinal tissues. CONCLUSIONS This biodegradable adhesive provides greater resistance, temporarily protects suture lines and may prevent anastomotic leaks.
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Affiliation(s)
- Jorge Cueto
- Health Sciences Faculty, Anahuac University, Bosque de Magnolias No. 87, Mexico City, Mexico.
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