Circular anastomotic experimental fibrin sealant protection in deep colorectal anastomosis in pigs in a randomized 9-day survival study

Wenger, F. A.; Szucsik, Eduard; Hoinoiu, Bogdan; Cimpean, Anca Maria; Ionac, Mihai; Raica, Marius

doi:10.1007/s00384-015-2260-4

Cited by 9 publications

(13 citation statements)

References 31 publications

(59 reference statements)

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“…In our previous follow-up survival study, we observed a 20% AL rate in CDSA after LAR until the ninth postoperative day compared with 5% leakage rate in the therapy group with an additional circular extraluminal fibrin glue sealant. 13 In our present 21-day follow-up trial, there were 20% ALs in the control group compared with 0% in the sealant group. The observed rate of leakages is within the range of literature in human patients.…”

Section: Discussionmentioning

confidence: 49%

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] Thus, our experimental model in pig again proved to be similar to the human pathomechanism of AL after LAR. 12,13 Moreover, we observed intraluminal wall defects at the crossing of linear and circular stapler in both trials. While these wall defects led to AL in the control group, the fibrin glue sealant prevented leakages as well after 9 postoperative days in the previous trial.…”

Section: Discussionmentioning

confidence: 69%

“…The fibrin sealant was present at necropsy in all treated animals on the ninth postoperative day. 13 Accordingly, the scope of the present trial was to find out whether extraluminal fibrin sealant protection in deep colorectal anastomosis is also sufficient to prevent AL after 21 postoperative days in a pig model.…”

Section: Introductionmentioning

confidence: 99%

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Is Circular Fibrin Sealing of Low Rectal Anastomosis Able to Prevent Leakage in 21-Day Follow-up? Randomized Experimental Trial in Pigs

et al. 2019

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Purpose. Clinically apparent anastomotic leakage (AL) after low anterior rectal resection (LAR; <7 cm from anal verge) using circular double-stapled anastomosis without defunctioning stoma is up to 37.5%. However, it is unclear whether there is reduction of LAR after 21 postoperative days without defunctioning stoma but with extraluminal anastomotic application of fibrin sealant. Methods. Forty-eight-week-old pigs underwent LAR and circular double-stapled anastomosis in end-to-end technique (descendo-rectostomy). Animals were randomized into therapy and control group (cg). Therapy group (n = 20) received additional extraluminal circular anastomotic application of fibrin sealant. Objective was to assess incidence of clinically apparent and nonclinically apparent leakage through the 21st postoperative day. Remaining animals were sacrificed on the 21st day, and anastomotic region was analyzed. In case of earlier diagnosed AL, animals were sacrificed. Results. In cg, we observed clinically and nonclinically AL in 20% (n = 4). No animal was identified with a nonclinical-apparent leakage in this group, and all 4 animals with leakages presented clinical signs. In the therapy group, no animal (0/20) developed clinically apparent leakage signs. There were no leakages in this group, but 3 animals had ulcerative lesions without leak and without clinical signs. These lesions were observed intraluminally at crossing of staple lines after 21 days. In one of these animals, incomplete leakage was observed, blocked by fibrin sealant. Conclusion. In circular stapled colorectal anastomosis, circular fibrin glue sealant successfully protected anastomotic intraluminal wall defects at crossing of staple lines, reducing leakage rate from 20% to 0% (cg vs therapy group) after 21 postoperative days.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 69%

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Is Circular Fibrin Sealing of Low Rectal Anastomosis Able to Prevent Leakage in 21-Day Follow-up? Randomized Experimental Trial in Pigs

et al. 2019

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“…A lot of studies have been carried out to find materials and surgical techniques for the purpose of protecting high-risk gastrointestinal anastomosis [5][6][7] . Peritoneum, collagen, and synthetic materials (polymers) and sealants have been investigated in previous studies for the purpose of protecting anastomosis and preventing AL [5][6][7][8][9] . Most of these studies are animal studies, and satisfactory results have not been obtained.…”

Section: Introductionmentioning

confidence: 99%

Effect of the wrapping of experimentally induced ischemic colonic anastomoses with the amniotic membrane on anastomosis safety in rats.

Soylu

İnan

2018

Cumhuriyet Medical Journal

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Colonic anastomotic leakage represents a complication with high mortality and morbidity. In the present study, it was aimed to examine the effect of the amniotic membrane on the healing of ischemic colonic anastomosis. Method: 25 pregnant Wistar albino rats aged 19-21 days were randomly divided into 5 groups. With midline laparotomy, pregnancies were terminated, and fresh amniotic membranes were obtained. In Group 1 Sham (S), no procedure except for laparotomy was performed. In Group 2 of colonic anastomosis (A), the descending colon was completely transected and anastomosed. In Group 3 of amniotic anastomosis (AA), the anastomosis line was fixed by being wrapped with the fresh amniotic membrane. In Group 4 of colonic ischemic anastomosis (IA), the marginal arteries were ligated after descending colon transection. Ischemia was induced, and anastomosis was performed. In Group 5 of colonic ischemic anastomosis wrapped with the amniotic membrane (AIA), after ischemic colonic anastomosis was performed, the anastomosis line was fixed by being wrapped with the amniotic membrane. On the postoperative 7th day, rats were sacrificed, and their anastomotic bursting pressures were measured. For histological examination, the colon segment containing the anastomosis line was removed. Hematoxylin-eosin and Van Gieson trichrome stained specimens were histologically evaluated and scored according to the Ehrlich-Hunt model. Results: Anastomotic bursting pressures were measured in group S as the highest, in AA, AIA, A in a decreasing order and in group IA as the lowest. The difference between groups S and AA was statistically insignificant in the paired comparison of groups according to their bursting pressure values (p=0.222). When the other pairs were compared, the difference between the groups was calculated as significant (p< 0.05). According to the Ehrlich-Hunt model, the total score was the highest in AIA group, decreased in AA, IA, A groups in a decreasing order, and was the lowest in group S. A paired comparison for total scores between the groups was statistically insignificant between groups S and A (p=0.222). Other paired comparisons were statistically significant (p< 0.05). Conclusions: Wrapping the colon anastomosis line with the amniotic membrane gave positive results both in the ischemic colon as well as in the non-ischemic colon in terms of bursting pressure and histological anastomosis safety.

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“…Allogeneic (peritoneum), xenolog (collagen), and synthetic materials (polymers) and sealants (fibrin) have been previously tested to protect the anastomosis and prevent AL and adherence formation. [6][7][8][9][10] Most of the trials were animal trials and have not yet been able to identify the optimal barrier to prevent adhesions in a sustainable way. 11 In most trials, detailed information on materials and methods according to IDEAL criteria is missing.…”

Section: Introductionmentioning

confidence: 99%

Human Amniotic Membrane Is Not Suitable for the Grafting of Colon Lesions and Prevention of Adhesions in a Xenograft Rat Model

et al. 2017

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Circular anastomotic experimental fibrin sealant protection in deep colorectal anastomosis in pigs in a randomized 9-day survival study

Abstract: Circular anastomotic protection with the experimental fibrin sealant blocked anastomotic full wall defects, preventing peritonitis and significantly reducing the AL rate from 25 to 5 %.

Cited by 9 publications

References 31 publications

Is Circular Fibrin Sealing of Low Rectal Anastomosis Able to Prevent Leakage in 21-Day Follow-up? Randomized Experimental Trial in Pigs

Is Circular Fibrin Sealing of Low Rectal Anastomosis Able to Prevent Leakage in 21-Day Follow-up? Randomized Experimental Trial in Pigs

Effect of the wrapping of experimentally induced ischemic colonic anastomoses with the amniotic membrane on anastomosis safety in rats.

Human Amniotic Membrane Is Not Suitable for the Grafting of Colon Lesions and Prevention of Adhesions in a Xenograft Rat Model

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