The Adjunctive Effect of DuraSeal® vs. 2-Octyl-Cyanoacrylate on Delayed Repair of Gastric Perforation: An Experimental Study

OBJECTIVE

Delayed primary suture closure of gastric perforation is prone to dehiscence hence the repaired area should be buttressed to avoid re-operation. We aimed to investigate whether DuraSeal®(DS) has a potent adjunctive effect on delayed closure of gastric perforation comparing with 2-octly-cyanoacrylate(CYN) in an experimental model.

METHODS

Sixty rats were randomly divided into 6 groups. All subjected to gastric perforation, subsequently perforation areas were repaired by primary suturing, delayed repair was performed 12 h after surgery. According to DS or CYN application on anastomosis, the groups were classified as control(C), delayed control(CD), closure with CYN(CYN), delayed closure with CYN(D-CYN), closure with DS(DS), delayed closure with DS(D-DS).After euthanization on POD 7,anastomotic bursting pressure(ABP) were measured. Tissue samples were taken for histopathological examination and hydroxyproline(TH) assessment.

RESULTS

Delayed condition significantly reduced ABP and TH levels in CD group comparing with all groups(p < 0.01).Either CYN or DS application on delayed repaired area significantly raised the measure of ABP and TH up to the levels of C group(p < 0.05,comparing with CD).Microscopically,either CYN or DS application significantly improved tissue necrosis, submucosal bridging and collagen formation comparing with CD group(p < 0.012).There were no difference regarding ABP, TH and tissue healing between each CYN and DS groups.

CONCLUSION

DuraSeal® application on sutured gastric perforation area yielded a significant adjunctive effect both in normal and delayed conditions. However, DuraSeal® revealed no superior effect to CYN in both condition.Our results demonstrated that the clinical use of DuraSeal® can be considered for reinforcing the sutured line in patients undergoing delayed surgery for gastric perforation.