Sealing of anastomoses has previously been tested with several methods, including sealing with liquid fibrin glue. Sealing with a collagen patch coated with fibrin glue components has never been systematically examined. The aim of the present study was to determine the safety of sealing gastrointestinal anastomoses with a collagen patch coated with fibrin glue. The study is a prospective, experimental animal study comparing sealed and unsealed gastrointestinal anastomoses. Laparotomy was performed in 11 pigs under general anesthesia. In each pig two anastomoses were performed on the small intestine. One of the anastomoses was sealed with a collagen patch coated with fibrin glue components (TachoSil). The other anastomosis contained no sealing. The pigs were observed for 1 to 6 weeks. The observation period was followed by in vivo examination under general anesthesia and included observation for anastomotic leakage, signs of present or former peritonitis, abscess, adhesions to the anastomoses, and signs of intestinal obstruction. In addition, the anastomotic diameter was measured with barium and radiography. Finally, bursting pressure was measured in each segment. After the pigs were sacrificed, the bowel segments were microscopically examined. There were no differences between the sealed and the unsealed anastomoses with respect to abdominal pathology, in vivo bursting pressure, or degree of stenosis. The collagen fleeces were in situ in all anastomoses. Microscopically, we found no difference in healing or signs of infection.

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.

Background: In order to investigate anastomotic leakage, a number of experimental animal studies have been previously carried out. Due to the low frequency of spontaneous anastomotic leakages, there have been studies on gastrointestinal anastomoses with iatrogenically produced leakages. A leakage model has only been developed in one gastric bypass study. The aim of the present study was to develop a leakage model of pig colon anastomoses. This type of study has never been performed before. Materials and Methods: Anastomosis was performed in 22 pigs. In all anastomoses a standardized rupture in the anastomotic line was made. The rupture ranged from 5 mm in the first group of pigs, increasing subsequently to 21 mm in the last group. Autopsy was performed after 7 days. The end points were macroscopic leakage and fecal peritonitis. Results: 6 out of the 6 pigs with a 21-mm rupture developed leakage and fecal peritonitis. In the groups with smaller ruptures, most of the pigs did not develop any signs of leakage or fecal peritonitis. The difference is significant. The group of pigs with peritonitis had significantly fewer adhesions to the anastomoses than the group without peritonitis. Conclusion: A model of anastomotic leakage on pig colon is developed with creation of a 21-mm rupture in the anastomotic line.

Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.