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Protection of intestinal anastomosis with biological glues: an experimental randomized controlled trial

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Abstract

Background

The aim of the study was to compare the degree of healing and air tightness of hand-sewn colonic anastomoses provided by different biological glues.

Methods

Thirty colonic anastomoses were fashioned in ten rabbits, at 5, 10, 15 cm from the ileocecal valve, with 4/0 PDS running sutures. Each suture was randomized to treatment with fibrin sealant (Tissucol®), a synthetic glue (Coseal®), or nothing (control). After 15 days, the rabbits were killed and the anastomoses examined for their integrity and resistance to bursting. The van der Hamm scale was used to evaluate postoperative adhesions. A blind histological evaluation of the newly formed tissue was made (Ehrlich–Hunt scale).

Results

Two rabbits developed an intraabdominal abscess, one in the control anastomosis group without glue. Postoperative adhesions were present in all animals. Median anastomosis bursting pressures were 0.9 atm in all three groups: Tissucol, Coseal, and control. Pressure values were 0.9, 1.0, and 0.9 atm in the three different proximodistal sites, respectively. A trend toward an increased resistance was observed in the glued anastomosis, although this was not significant. Lymphocyte infiltration, fibroblast activity, blood vessel density, and collagen deposition were lower in controls. Anastomoses treated with Tissucol had the highest lymphocyte infiltration level. The Coseal group developed the highest rates of fibroblast activity, collagen deposition, and blood vessel neogenesis.

Conclusion

The use of biological glues did not result in a statistically significantly increased bursting resistance. Histological evaluation demonstrated more intense tissue neoformation in the glue groups, particularly in the Coseal group. The role of biological glues in decreasing the leakage rate of intestinal anastomoses is uncertain, and larger trials using different protective agents are warranted.

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References

  1. Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ (1995) Comparison of manually constructed and stapled anastomoses in colorectal surgery. Ann Surg 221:176–184

    Article  PubMed  CAS  Google Scholar 

  2. Lee WS, Yun SH, Roh YN et al (2008) Risk factors and clinical outcome for anastomotic leakage after total mesorectal excision for rectal cancer. World J Surg 32:1124–1129

    Article  PubMed  Google Scholar 

  3. Branagan G, Finnis D (2005) Wessex colorectal cancer audit working group prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48:1021–1026

    Article  PubMed  Google Scholar 

  4. Eberl T, Jagoditsch M, Klingler A, Tschmelitsch J (2008) Risk factors for anastomotic leakage after resection for colorectal cancer. Am J Surg 196:592–598

    Article  PubMed  Google Scholar 

  5. Eriksen MT, Wibe A, Norstein J, Haffner J, Wiig JN (2005) Norwegian rectal cancer group. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 7:51–57

    Google Scholar 

  6. Buchs NC, Gervaz P, Secic M, Bucher P, Mugnier-Konrad B, Morel P (2008) Incidence, consequences and risk factors for dehiscence after colorectal surgery: a prospective, monocentric study. Int J Colorectal Dis 23:265–270

    Google Scholar 

  7. Merad F, Hay JM, Fingerhut A et al (1998) Omentoplasty in the prevention of anastomotic leakage after colonic or rectal resection: a prospective randomized study in 712 patients. Ann Surg 227:179–186

    Article  PubMed  CAS  Google Scholar 

  8. Van der Ham AC, Kort WJ, Weijma IM, van den Ingh HF, Jeekel H (1992) Effects of antibiotics in fibrin sealant on healing colonic anastomosis in the rat. Br J Surg 79:525–528

    Article  PubMed  Google Scholar 

  9. Miliaras S, Beveridge E, Campbell C, Sunderland G, MacDonald A (2000) Fluid collections detected by ultrasound following uncomplicated colorectal surgery. Br J Radiol 73:1098–1099

    PubMed  CAS  Google Scholar 

  10. Yeh CY, Changchien CR, Wang JY et al (2005) Pelvic drainage and other risk factors for leakage rate after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 241:9–13

    PubMed  Google Scholar 

  11. Law WI, Chu KW, Ho JW, Chan CW (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. Am J Surg 179:92–96

    Article  PubMed  CAS  Google Scholar 

  12. Fingerhut A, Hay JM (1993) Single-dose ceftriaxone, ornidazole, and povidone-iodine enema in elective left colectomy. A randomized multicenter controlled trial. The French association for surgical research. Arch Surg 128:228–232

    PubMed  CAS  Google Scholar 

  13. Fry DE (1993) Preventive systemic antibiotics in colorectal surgery. Surg Infect (Larchmt) Dec 9:547–552

    Article  Google Scholar 

  14. Fawcett A, Vashisht R, Shankar A et al (1995) Microvascular disease and anastomotic dehiscence in the colon. Br J Surg 82:1483–1485

    Article  PubMed  CAS  Google Scholar 

  15. Da Silva Lustosa SA, Matos D, Atallah AN, Castro AA (2002) Stapled versus handsewn methods for colorectal anastomotic surgery: a systematic review of randomized controlled trials. Sao Paulo Med J 120:132–136

    Google Scholar 

  16. Keighley MRB, Williams NS (2008) Surgery of the anus, rectum & colon, 3rd edn. vol. 1. Chap. 4: surgical principles. Saunders Elsevier, pp 144–170

  17. Vignali A, Fazio VW, Lavery IC et al (1997) Factors associated with the occurrence of leaks in stapled rectal anastomoses: a review of 1014 patients. J Am Coll Surg 185:105–113

    PubMed  CAS  Google Scholar 

  18. Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie AE (2007) Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev 3: CD004320

  19. Moran BJ (1996) Stapling instruments for intestinal anastomosis in colorectal surgery. A review. Br J Surg 83:902–909

    Article  PubMed  CAS  Google Scholar 

  20. Alves A, Panis Y, Trancart D, Regimbeau JM, Pocard M, Valleur P (2002) Factors associated with clinical significant anastomotic leakage after large bowel resection: multivariate analysis of 707 patients. World J Surg 26:499–502

    Article  PubMed  Google Scholar 

  21. Kruschewski M, Rieger H, Pohlen U, Hotz HG, Buhr HJ (2007) Risk factors for clinical anastomotic leakage and postoperative mortality in elective surgery for rectal cancer. Int J Colorectal Dis 22:919–927

    Article  PubMed  Google Scholar 

  22. Matthiessen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469

    Article  PubMed  CAS  Google Scholar 

  23. Makela JT, Kiviniemi H, Laitinem S (2003) Risk factors for anastomotic leakage after left-sided colorectal resection with rectal anastomosis. Dis Colon Rectum 46:653–660

    Article  PubMed  Google Scholar 

  24. den Dulk M, Noter SL, Hendriks ER et al (2009) Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol 35:420–426

    Google Scholar 

  25. Sugarbaker PH (1996) Progressive release of the left colon for a tension-free colorectal or coloanal anastomosis. Cancer Treat Res 82:255–261

    PubMed  CAS  Google Scholar 

  26. Hogstrom H, Haglund U, Zederfeldt B (1985) Suture technique and early breaking strength of intestinal anastomoses and laparotomy wounds. Acta Chir Scand 151:441

    PubMed  CAS  Google Scholar 

  27. Beard JD, Nicholson ML, Sayers RD, Lloyd D, Everson NW (1990) Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial. Br J Surg 77:1095–1097

    Article  PubMed  CAS  Google Scholar 

  28. Veyrie N, Ata T, Muscari F et al (2007) French associations for surgical research. Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. Am Coll Surg 205:785–793

    Article  Google Scholar 

  29. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjödahl R (2007) Defunctioning stoma reduces symptomatic leakage after anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    Article  PubMed  Google Scholar 

  30. Rahbari NN, Weitz J, Hohenberger W et al (2010) Definition and grading of anastomotic leakage following anterior resection of the rectum. A proposal by the International study group of rectal cancer. Surg Mar 147:339–351

    Google Scholar 

  31. Silecchia G, Boru CE, Mouiel J et al (2008) The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial. Surg Endosc 22:2492–2497

    Article  PubMed  Google Scholar 

  32. Soeters PB, de Zoete JP, Dejong CH et al (2002) Colorectal surgery and anastomotic leakage. Dig Surg 19:150–155

    Article  PubMed  CAS  Google Scholar 

  33. Rudinskaitè G, Tamelis A, Saladzinskas Z, Pavalkis D (2005) Risk factors for clinical anastomotic leakage following the resection of sigmoid and rectal cancer. Medicina 41:741–746

    PubMed  Google Scholar 

  34. Beati C, Raviolo C, Palazzolo C (2008) Anastomotic complications after low colorectal anastomosis with protective defunctioning ileostomy. Tech Coloproctol 12:368–369

    Google Scholar 

  35. Kanellos D, Blouhos K, Pramateftakis MG et al (2007) Effect of 5-fluorouracil plus interferon on the integrity of colonic anastomoses covering with fibrin glue. World J Surg 31:186–191

    Article  PubMed  CAS  Google Scholar 

  36. Kanellos I, Mantzoros I, Demetriades H et al (2004) Healing of colon anastomoses covered with fibrin glue after immediate postoperative intraperitoneal administration of 5-fluorouracil. Dis Colon Rectum 47:510–515

    Article  PubMed  CAS  Google Scholar 

  37. Huh JW, Kim HR, Kim YJ (2010) Anastomotic leakage after laparoscopic resection of rectal cancer: the impact of fibrin glue. Am J Surg 199:435–441

    Article  PubMed  Google Scholar 

  38. Jackson MR (2001) Fibrin sealants in surgical practice: an overview. Am J Surg 182:1S–7S

    Article  PubMed  CAS  Google Scholar 

  39. Ehrlich HP, Tarver H, Hunt TK (1973) Effects of vitamin A and glucocorticoids upon inflammation and collagen synthesis. Ann Surg 177:222–227

    Article  PubMed  CAS  Google Scholar 

  40. Philips JD, Kim CS, Fonkalsrud EW et al (1992) Effects of chronic corticosteroids and vitamin A on the healing of intestinal anastomoses. Am J Surg 163:71–77

    Article  Google Scholar 

  41. Bae KB, Kim SH, Jung SJ, Hong KH (2010) Cyanoacrylate for colonic anastomosis; is it safe? Int J Colorectal Dis 25:601–606

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors acknowledge the contribution of Baxter® SpA, which generously provided the Tissucol and Coseal kits.

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Authors and Affiliations

  1. Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Bari, Italy

    S. Giuratrabocchetta, M. Rinaldi, F. Cuccia, M. Lemma & D. F. Altomare

  2. Department of Human Pathology, University Aldo Moro of Bari, Bari, Italy

    D. Piscitelli

  3. S. Antonio Abate Veterinary Medical Center, Capurso, Bari, Italy

    P. Polidoro

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  1. S. Giuratrabocchetta
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  2. M. Rinaldi
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  3. F. Cuccia
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  4. M. Lemma
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  5. D. Piscitelli
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  7. D. F. Altomare
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Correspondence to D. F. Altomare.

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Giuratrabocchetta, S., Rinaldi, M., Cuccia, F. et al. Protection of intestinal anastomosis with biological glues: an experimental randomized controlled trial. Tech Coloproctol 15, 153–158 (2011). https://doi.org/10.1007/s10151-010-0674-0

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