Abstract
Background
Anastomotic leak after colorectal surgery is a significant cause of morbidity and
mortality. The aim of this study was to evaluate the impact of a reinforced colo-colonic
anastomosis with tissue adhesive, 2-octylcyanoacrylate (2-OCA), on the integrity of
anastomotic healing as measured by anastomotic bursting pressure.
Methods
Sixty-eight female Sprague–Dawley rats underwent a rectosigmoid colon transection
and a sutured end-to-end anastomosis followed by randomization to receive no further
intervention or reinforcement with the tissue adhesive, 2-OCA. After seven postoperative
days, a macroscopic assessment of the anastomosis, mechanical assessment to determine
anastomotic bursting pressure, and a detailed semi-quantitative histopathologic healing
assessment were performed.
Results
Thirty-four animals were randomized to each group. Study characteristics did not differ
between the groups. There was also no difference in the degree of adhesions present
postoperatively. Although there was no difference between the net proximal and distal
luminal areas in the two groups (0.37 cm2 versus 0.55 cm2, P = 0.26), the 2-OCA group exhibited evidence of stricture in 15% of anastomoses as
compared with 3% in the suture-only group (P < 0.0001). Histologically, the presence of only fibroblasts density was statistically
more evident in the 2-OCA group compared with the sutured-only anastomosis (P = 0.0183). There was not a significant increase in mechanical strength in the 2-OCA
group (238.9 mm Hg) versus in the suture-only group (231.8 mm Hg). There was no difference in the rate of anastomotic
leak in the 2-OCA as compared with the suture-only group (9.1 versus 8.8%).
Conclusions
Application of 2-OCA to reinforce a colo-colonic anastomosis clinically provides no
benefit to its mechanical strength and detrimentally increases the rate of obstruction
and/or stricture in this in vivo model.
Keywords
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References
- Multiple large bowel resections: potential risk factor for anastomotic leak.Gynecol Oncol. 2013; 130: 213-218
- Long-term and perioperative corticosteroids in anastomotic leakage: a prospective study of 259 left-sided colorectal anastomoses.Arch Surg. 2012; 147: 447
- Colonic anastomotic leak: risk factors, diagnosis, and treatment.J Am Coll Surg. 2009; 208: 269
- Anastomotic leaks after intestinal anastomosis: it's later than you think.Ann Surg. 2007; 245: 254
- Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group.Ann Surg. 2013; 257: 665
- Postoperative complications.in: Church J.M. Beck D.E. Wolff B.G. Fleshman J.W. Pemberton J.H. ASCRS Textbook of Colon and Rectal Surgery. Springer-Verlag New York, LLC, New York2006: 141
- Prophylactic abdominal drainage after elective colonic resection and suprapromontory anastomosis: a multicenter study controlled by randomization. French Associations for Surgical Research.Arch Surg. 1998; 133: 309
- Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients.Ann Surg. 2005; 241: 9
- Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: case-control using propensity score matching method.Am J Surg. 2014; 207: 840
- Fibrin glue does not improve healing of gastrointestinal anastomoses: a systematic review.Eur Surg Res. 2015; 54: 1-13
- Routine drainage of colorectal anastomoses: an evidence-based review of the Current literature.Gastroenterol Res Pract. 2017; 2017: 6253898
- Protective defunctioning stoma in low anterior resection for rectal carcinoma.Br J Surg. 2005; 92: 1137
- Systematic review and meta-analysis of the role of defunctioning stoma in low rectal cancer surgery.Ann Surg. 2008; 248: 52
- Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial.Ann Surg. 2007; 246: 207
- Ostomy-related problems and their impact on quality of life of colorectal cancer ostomates: a systematic review.Qual Life Res. 2016; 25: 125-133
- DERMABOND ADVANCED™ Topical skin adhesive instructions for use.(Ethicon, Inc., PM72434B. LAB0012189.2. STATUS:03/2011. Available at:)
- In vitro assessment of microbial barrier properties of Dermabond topical skin adhesive.Surg Infect (Larchmt). 2002; 3: 251-257
- Histoacryl in sutureless uretero-ureteral anastomosis: an experimental study.Isr J Med Sci. 1981; 17: 254-256
- Sutureless vascular anastomoses by N-Butyl-2 cyanoacrylate adhesive: an experimental animal study.Eur Surg Res. 2007; 39: 239-244
- Prospective randomized study evaluating an absorbable cyanoacrylate for use in vascular reconstructions.J Vasc Surg. 2006; 44: 1002-1009
- Improved intraoperative management of anastomotic bleeding during aortic reconstruction: results of a randomized controlled trial.Am Surg. 2004; 70: 307-311
- Tissue adhesive in bronchial closure. Updated in 1997.Ann Thorac Surg. 1997; 63: 899-900
- Topically applied 2-octyl cyanoacrylate (Dermabond) for prevention of postoperative pancreatic fistula after pancreaticoduodenectomy.J Gastrointest Surg. 2012; 16: 1499-1507
- The effect of tissue adhesive, octyl-cyanoacrylate, on the healing of experimental high-risk and normal colonic anastomoses.Am J Surg. 2004; 187: 28-32
- Sutureless colonic anastomosis in the rat: a randomized controlled study.Tech Coloproctol. 2002; 6: 143-146
- Is the use of cyanoacrylate in intestinal anastomosis a good and reliable alternative?.J Pediatr Surg. 2009; 44: 581-586
- Cyanoacrylate for colonic anastomosis; is it safe?.Int J Colorectal Dis. 2010; 25: 601-606
- Effect of 2-octylcyanoacrylate on ischemic anastomosis of the left colon.J Invest Surg. 2009; 22: 188-194
- The use of cyanoacrylate in surgical anastomosis: an alternative to microsurgery.J Surg Tech Case Rep. 2010; 2: 44-48
- Suture-Free anastomosis of the colon experimental comparison of two cyanoacrylate adhesives.J Gastrointest Surg. 2011; 15: 451-459
- Reducing anastomotic leakage by reinforcement of colorectal anastomosis with cyanoacrylate glue.Eur Surg Res. 2013; 50: 255-261
- Critical analysis of cyanoacrylate in intestinal and colorectal anastomosis.J Biomed Mater Res B Appl Biomater. 2014; 102B: 635-642
- Glued versus stapled anastomosis of the colon: an experimental study to determine comparative resistance to intraluminal pressure.Asian J Surg. 2014; 37: 154-161
- The burden of gastrointestinal anastomotic leaks: an evaluation of clinical and economic outcomes.J Gastrointest Surg. 2014; 18: 1176-1185
- Transient protection of incomplete colonic anastomoses with fibrin sealant: an experimental study in the rat.J Surg Res. 1993; 55: 256-260
- Effects of vitamin A and glucocorticoids upon inflammation and collagen synthesis.Ann Surg. 1973; 177: 222-227
- Impact of tissue adhesives on the prevention of anastomotic leakage of colonic anastomoses: an in vivo study.Int J Colorectal Dis. 2017; 32: 961-965
- Histoacryl blue versus sutured left colonic anastomosis: experimental study.ANZ J Surg. 2004; 74: 1107-1110
- Bowel anastomoses: the theory, the practice and the evidence base.World J Gastrointest Surg. 2012; 4: 208-213
- Reinforcement of the colon anastomosis with cyanoacrylate glue: a porcine model.J Surg Res. 2017; 217: 84-91
- The effect of fibrin glue on the early healing phase of intestinal anastomoses in the rat.Int J Colorectal Dis. 2012; 27: 1101-1107
- Anastomotic sealing by extracellular matrices (ECM) improves healing of colonic anastomoses in the critical early phase.J Gastrointest Surg. 2010; 14: 977-986
- Intra-abdominal healing: gastrointestinal tract and adhesions.Surg Clin North Am. 2010; 90: 1227-1236
- Collagen degradation and MMP9 activation by Enterococcus faecalis contribute to intestinal anastomotic leak.Sci Transl Med. 2015; 7: 286ra68
Article info
Publication history
Published online: February 20, 2018
Accepted:
January 17,
2018
Received in revised form:
January 8,
2018
Received:
November 22,
2017
Identification
Copyright
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