Reducing Anastomotic Leakage by Reinforcement of Colorectal Anastomosis with Cyanoacrylate Glue

Abstract

Introduction: Technical failure of sutured or stapled anastomoses may lead to anastomotic leakage, which is one of the most important complications after colorectal surgery. Cyanoacrylate glue (CA) provides strong mechanical attachment, making it a good candidate for suture reinforcement. This study aimed to demonstrate that CA is the most important factor in the strength of a sealed colorectal anastomosis, in both normal and insufficient anastomoses. Methods: Ex vivo porcine colorectal segments were resected. A 1-layer continuous anastomosis or an insufficient 6-interrupted-suture anastomosis was created, and the baseline anastomotic bursting pressure (ABP) was measured. The primary anastomosis was then reinforced either by CA or with 4 additional interrupted sutures, further inverting the anastomosis. After reinforcement a second ABP test was performed. Results: Thirty-two segments were used. Reinforcing the anastomosis by CA significantly increased ABP in both normal and insufficient anastomoses when compared to the primary anastomosis (p < 0.05 for all groups); no significant difference in ABP was found between normal and insufficient anastomosis groups after CA reinforcement. Anastomotic reinforcement with CA was not inferior to the reinforcement with sutures in both normal and insufficient anastomoses, and had significantly fewer ABP variances in normal anastomosis groups (p = 0.042). Conclusion: Reinforcing a colorectal anastomosis with CA increases its mechanical strength in both normal and technically insufficient situations, which may contribute to the reduction of anastomotic leakage. CA is promising for anastomotic reinforcement based on mechanical improvement of the anastomosis, and in vivo studies are needed to evaluate its biological effects.

Comparison of conventional suturing and tissue adhesive (2-octyl cyanoacrylate) for port site skin closure in laparoscopic surgeries

“…3 Apart from using it for skin closure, various studies have been conducted showing the versatile use of 2-octyl cyanoacrylatye like reinforcing a colorectal anastamosis or a pacreaticojejunostomy, or repairing a clitoral laceration. 4,6 This study consisted of clean and clean contaminated laprascopic surgeries which mainly comprised of laparoscopic cholecystectomies, laparoscopic appendicectomies, laparoscopic hernia repairs and diagnostic laparoscopy.…”

“…3,4 Tissue adhesive were invented in 1949 and tried clinically for the first time in 1959. This procedure allows for normal wound healing and is accomplished without the need of local anaesthesia or entry of foreign material.…”

Reducing Colorectal Anastomotic Leakage with Tissue Adhesive in Experimental Inflammatory Bowel Disease

“…8,17,27 Such reinforcement may further provide a firm contact between the cutting edges, creating an ideal environment for anastomotic healing. Moreover, more M2 macrophages were observed at the serosal-adhesive interface in the Histoacryl group, which are known to foster regenerative responses such as the stimulation of collagen production.…”

“…To this end, in this study, we developed a novel surgical IBD model by combining the rat colectomy model with the trinitrobenzene sulfonic acid (TNBS)-induced colitis model and determined the effect of the tissue adhesives on anastomotic healing and the involvement of macrophage subtypes in this model. 16,17 The results show that tissue adhesives and especially Histoacryl Flex improves outcome, which open the way for human trials testing this adhesive in the surgical treatment of patients with IBD.…”

Comparative study between cyanoacrylate tissue adhesive versus skin sutures in closure of wound in 60 operated cases of open inguinal hernia

“…3,4 Tissue adhesive were invented in 1949 and tried clinically for the first time in 1959. This procedure allows for normal wound healing and is accomplished without the need of local anesthesia or entry of foreign material.…”