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

Giuratrabocchetta, Simona; Rinaldi, Marcella; Cuccia, Filippa; Lemma, Maria; Piscitelli, Domenico; Polidoro, P.; Altomare, D. F.

doi:10.1007/s10151-010-0674-0

Cited by 29 publications

(23 citation statements)

References 41 publications

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“…In one case, additional information about the significance of the results was obtained from the authors [54]. The primary outcome of the present review was the healing effect of FG on anastomoses.…”

Section: Methodsmentioning

confidence: 99%

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

et al. 2014

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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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Section: Methodsmentioning

confidence: 99%

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

et al. 2014

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“…Materials such as GLU, short-chain fatty acids, erythropoietin, fibrin glue and peritoneal graft have been experimentally reported to be beneficial in the healing of colonic anastomoses. [1][2][3]10,14,15 ARG is a dietary semi-essential amino acid and it is metabolized to ornithine and subsequently to proline and polyamines both known to interact in collagen synthesis. 4,16 Dietary ARG supplementation increases wound collagen accumulation.…”

Section: Discussionmentioning

confidence: 99%

The Effect of a Special Amino Acid Mixture on Healing of Left Colonic Anastomosis: an Experimental Study

Yaman¹,

Kara²,

Derıcı³

et al. 2013

Turkiye Klinikleri J Med Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Arginine, glutamine, and Beta-hydroxy-beta-methylbutyrate were combined in a dietary supplement. This specialized amino acid mixture enhances wound collagen accumulation and increases wound healing. We aimed to investigate the effects of this special amino acid mixture on the healing process of experimental left colonic anastomosis. M Ma at te er ri ia al l a an nd d M Me et th h--o od ds s: : The study included 20 adult male Wistar-Albino rats. The study group (n=10) received 685 mg/kg/day specialized amino acid mixture for 7 days until 12 h before surgery and was maintained throughout the study. Following midline laparatomy a 1-cm segment of the left colon was resected. Bowel continuity was restored with an end-to-end anastomosis. The animals were re-anesthetized on day 7 after the operation and anastomotic bursting pressure was measured by passing a catheter per anum up to the area of anastomosis. Anastomotic segments were removed en bloc and were vertically divided into two. One was used for hydroxyproline measurement and the other for histopathological examination. Abramov's histologic scoring system was used in this study. R Re es su ul lt ts s: : The hydroxyproline levels and bursting pressures in the study group were superior compared to the control group. Collagen deposition and reepithelization scores of the study group were higher than that of the control group. C Co on nc cl lu us si io on n: Results of the present study indicates that significantly enhancing the anastomotic bursting pressure, hydroxyproline level and collagen deposition may improve anastomosis healing.K Ke ey y W Wo or rd ds s: : Colorectal surgery; arginine; glutamine; beta-hydroxyisovaleric acid Ö ÖZ ZE ET T A Am ma aç ç: : Arjinin, glutamin ve beta-hidroksi-beta-metilbütirat, diyet desteği olarak kombine edilmiştir. Bu özel amino asit karışımı, yara yerinde kollajen birikimini artırır ve yara iyileşmesini geliştirir. Bu çalışmanın amacı, deneysel sol kolon anastomozunun iyileşmesinde özel amino asit karışımının etkilerini araştırmaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Çalışmada 20 adet yetişkin Wistar-Albino sıçan kullanıldı. Çalışma grubu (n=10) ameliyattan 7 gün öncesinden başlayarak tüm çalışma süresince 685 mg/kg/gün özel amino asit karışımı aldı. Orta hattan karın açıldı ve 1 cm'lik sol kolon segmenti rezeke edildi. Uç-uca anastomoz yapılarak barsak lümeninin devamlılığı sağlandı. Sıçanlara bu ameliyattan 7 gün sonra tekrar anestezi verildi. Anastomoz patlama basıncı, anüsten yerleştirilip anastomozun üzerine çıkan bir kateter ile ölçüldü. Anastomoz sahaları sağlam sınırlarla çıkarıldı ve dikey olarak iki parçaya bölündü. Bir parça hidroksiprolin ölçümünde, diğer parça histolojik değerlendirmede kullanıldı. Histolojik değerlendirme için Abramov'un skorlama sistemi kullanıldı. B Bu ul lg gu ul la ar r: : Hiroksiprolin düzeyleri ve patlama basınçları çalışma grubunda, kontrol grubuna göre daha yüksekti. Kollajen birikimi ve reepitelizasyon skorları ç...

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“…Histological evaluation is useful to describe the course and results of the healing sequence at the tissue level as well as the successive infiltration of various cell types into the wound area. Various histological parameters of wound repair have been studied in experimental intestinal anastomoses: mucosal healing based on inflammatory cell infiltration, epithelial regeneration, the degree of necrosis, proliferation of fibroblasts, the formation of collagen fibers, neoangiogenesis and granulation tissue [18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…During the examination, each anastomosis was macroscopically assessed using the van der Hamm scale, which includes the formation of adhesions, the integrity of the anastomosis and the presence of a perianastomotic abscess or peritonitis (Table 1) [18,19]. The anastomoses were carefully dissected with 5 cm of bowel margin on each side of each anastomosis.…”

Section: Macroscopic Examinationmentioning

confidence: 99%

“…Histological parameters were graded from 0 to 4 using the Ehrlich-Hunt scale as modified by Philips et al; the scale included inflammatory cell infiltration (white blood cell count), fibroblast activity, neoangiogenesis, and collagen deposition (Table 1) [18][19][20]. Re-epithelialization was scored from 0 to 2, and the degree of wound healing at the line of the anastomosis was graded on a scale of 1 to 5 (Table 1) [17,21,22].…”

Section: Histological Examinationmentioning

confidence: 99%

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Compression Anastomosis Clips Versus a Hand-Sewn Technique for Intestinal Anastomosis in Pigs

Kuśnierz¹,

Kajor²,

Żaworonkow³

et al. 2016

Adv Clin Exp Med

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Different types of sutures, staples and sutureless anastomoses have been used to create anastomoses. The ideal device should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time [2]. Healing occurs when the surgical wound is clean and sharp, Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality, thus decreasing overall survival. Intestinal anastomosis healing depends on the operative technique, the underlying medical condition, medical treatment and other individual, often unknown, factors AbstractBackground. Anastomotic dehiscence and leaks are major problems in gastrointestinal surgery and result in increased morbidity and mortality. The ideal device to create anastomoses should ensure good serosal apposition without requiring either transgression of the bowel wall or the presence of foreign material for an extended period of time. Objectives. The aim of this experimental study was to evaluate the safety and efficacy of a new compression anastomosis clip (CAC) for jejunojejunostomies and ileocolostomies by comparing CAC anastomoses with hand-sewn (HS) anastomoses in pigs in terms of healing, breaking strength and the time to create anastomoses. Material and Methods. The 11 pigs in the study underwent side-to-side CAC and HS jejunojejunostomies and ileocolostomies, for a total of 88 anastomoses. The pigs were sacrificed on postoperative day 5 (5 pigs) or 7 (6 pigs). Macroscopic, histopathological and breaking-strength examinations were performed. The time to create the anastomoses was recorded. Results. Neither group had anastomotic complications such as leakage or obstruction. Macroscopic examination showed no statistically significant differences between the groups. In the CAC group, the healing process was characterized by a lesser inflammatory reaction (p < 0.05) and very thin scar tissue at the anastomotic line (less collagen deposition and better epithelial regeneration), while the HS group had a much thicker anastomotic line. The breaking strength was significantly greater in the CAC group compared with the HS group (p < 0.05). The anastomosis time was shorter in the CAC group than in the HS group (p < 0.01). Conclusions. Anastomosis using a CAC appears to be safe and less time-consuming than HS; it was also characterized by a good healing process with little inflammatory reaction and a high breaking strength compared with HS anastomosis (Adv Clin Exp Med 2015, 24, 6, 000-000).

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

Cited by 29 publications

References 41 publications

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

The Effect of a Special Amino Acid Mixture on Healing of Left Colonic Anastomosis: an Experimental Study

Compression Anastomosis Clips Versus a Hand-Sewn Technique for Intestinal Anastomosis in Pigs

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