A comparison of the application of brin glue and adhesive lm for repair of anastomotic leaks in the rat

Background: Anastomotic leaks constitute one of the most serious intraoperative complications and although many studies have been devoted to nding a solution for this problem, none of them has yet been able o er a decisive, successful method. In this study, the ability of brin glue and adhesive lm to repair anastomotic leaks in an experimental model was compared. Materials and methods: e sample comprised four groups of seven rats: Group 1 (Control): the distal colon was transected and anastomosis was performed. Group 2 (Primary repair): incomplete anastomosis produced a leak that was closed by primary repair on day 3. Group 3 (Fibrin glue): incomplete anastomosis produced a leak that was closed by primary repair and brin glue applied on day 3. Group 4 (Adhesive lm): incomplete anastomosis produced a leak that was closed by primary repair and adhesive lm was applied on day 3. e rats were sacri ced on day 6 following anastomosis. Anastomotic blast compressions were measured and broblast activation, in ammation, neovascularization and levels of collagen were evaluated. Results: e results from Group 4 showed that blast compression values were high and statistically signi cantly increased over control values (p < 0.05). In ammation in Group 2 was signi cantly higher than the other groups (p < 0.05). No signi cant di erences were detected in the comparison of the groups regarding the other scoring criteria (p > 0.05). Conclusion: Adhesive lm is more e ective in reducing anastomotic leakage than brin glue. ORIGINAL RESEARCH © 2012 CIM Clin Invest Med • Vol 35, no 4, August 2012 E216 Correspondence to: Erikoğlu Mehmet, M. D., Assoc. Prof. Meram Yeniyol cad, Armagan Mah. Duvarcı Apt.No: 32-2 – Meram Konya, Turkey e-mail: [email protected] Manuscript submitted 20th March, 2012 Manuscript accepted 27th May, 2012 Clin Invest Med 2012; 35 (4): E216-E222. Leaks developing a er colon anastomosis constitute one of the most important causes of surgical morbidity and mortality. Although many approaches have been used for the repair of anastomotic leaks, no optimal treatment has yet been identied. Some studies have investigated the e ects of brin glues on colon anastomoses and concluded that an e ective anastomotic repair can be achieved through the application of brin glue to the sutured area. Fibrin glues are natural hemostatic agents which contain thrombin + brinogen + factor XIII + aprotinin + calcium. ey are used on organs that are di cult to suture, such as the liver and spleen, to stop hemostatis and secretion in areas that are di cult to reach, in nerve and vein anastomoses, parenchymatous bleeding, hemophilia and other coagulation defects, as well as many other surgical operations, and have been found to shorten the period of surgery [1,2,3,4]. Adhesive surgical lm (Tissue Patch®; Tissuemed Ltd. UK) is a new surgical material in which the carboxylic acid groups provide the initial adherence via electrostatic interactions with amine and nucleophilic functionalities on tissue surfaces. Amide bonds then form rapidly between the surgical lm and the tissue surface. Because the lm is exible, it adheres to the tissue leaving no gaps and completely seals the wound. It is used in the treatment of pulmonary air leaks in thoracic surgery, in dura repairs in neurosurgery and in the prevention of blood and uid leaks in general surgery [5]. is study examines the e cacy of brin glue and adhesive lm to repair anastomotic leaks. e stability of the anastomosis was evaluated by anastomotic blast pressure and histopathology. Materials and Methods is study was carried out with the consent of the Board of Ethics at Necmettin Erbakan University, Meram Medical School Hospital, and Experimental Animal Research Laboratory. Wistar Albino female rats weighing 200-250 g (28 animals) were divided into four groups of seven. ey were kept at 25oC and fed with standard rat food and normal tap water every twelve hours. Group 1 (n = 7): Control group (Transection + anastomosis group): e distal colon was transected at the full layer and complete anastomosis was performed with a 6/0 vicryl suture. Group 2 (n = 7): Primary repair group: e distal colon was transected at the full layer and sutured with a 6/0 vicryl suture. Incomplete anastomosis of the colon produced a 5 mm opening on the anti-mesenteric side. On day 3 a er the procedure primary repair was carried out. Group 3 (n = 7): Fibrin glue group: e distal colon was transected at the full layer and was sutured with a 6/0 vicryl suture. Incomplete anastomosis of the colon produced a 5 mm opening on the anti-mesenteric side. On day 3 a er the procedure, the leak was repaired with 6/0 vicryl sutures and brin glue (Tisseel Fibrin Sealant®, Baxter Healthcare Corp. USA) was applied to the repaired area with a 5 mm run over to both the distal and the proximal surfaces. Group 4 (n = 7): Adhesive lm group: e distal colon was transected at the full layer and sutured with 6/0 vicryl. Incomplete anastomosis of the colon produced a 5 mm opening on the anti-mesenteric side. On day 3 following the procedure, the leak was repaired with 6/0 vicryl sutures and adhesive lm (Tissue Patch®) was applied to the repaired area with a 5 mm run over to both the distal and the proximal surfaces.