Human fibrinogen and thrombin patch for extraluminal protection of intestinal anastomosis

Abstract

In spite of recent advances regarding equipment and surgical techniques in colorectal surgery, rates of anastomotic dehiscence (AD) have remained stable throughout the years. The development of products to protect anastomosis aiming the reduction of AD rates has shown to be promising. Human fibrinogen and thrombin patch (HFTP Tachosil®) have been used in experimental studies in animals and small case series in humans, with promising results. In this study, the authors describe the technique of HFTP use in details, aiming the protection of colorectal anastomosis, and retrospectively demonstrate the preliminary results in a pilot case series. HFTP was used in 4 patients submitted to conventional surgery. The procedures performed were: left colon resection, segmental colectomy (both for colorectal cancer), enteral anastomosis for fistula closure and right ileocolectomy. Anastomotic healing and absence of complications were observed in 3 patients, and the patient submitted to right ileocolectomy developed AD and died after reoperation. The use of HFTP is safe and can be indicated in selected cases. However, AD can occur even after the use of this strategy. Randomized controlled trials with larger samples of patients are needed in order to properly define the real benefits of this strategy in dehiscence prevention

Anastomosis yeyunal término-terminal con xenoinjerto de pericardio bovino en equinos

“…No obstante, estos resultados difieren de otros reportes que describen que el refuerzo con vellones de colágeno tratado puede causar obstrucción intestinal Es importante indicar que los resultados obtenidos se circunscriben a las características de este estudio. Kotze et al (2013) exponen claramente las condiciones del pronóstico, mencionando que la predicción de la dehiscencia anastomótica no es posible por la influencia de factores relacionados con el paciente, como edad, sexo, nivel de albuminemia, uso de corticosteroides y el estado ASA. Asimismo, se tienen elementos relacionados con el procedimiento quirúrgico (la tensión en el lugar de la anastomosis, el suministro de sangre, la duración de la cirugía) y la condición intestinal (enfermedad inflamatoria, neoplasias, metástasis y peritonitis que también juegan un papel preponderante en la curación anastomótica) (Davis y Rivadeneira, 2013).…”