Clinical, mechanical, and immunohistopathological effects of tissue adhesives on the colon: An in‐vivo study

Abstract

Background: Tissue adhesives may be useful for sealing bowel anastomoses by preventing anastomotic leakage. Prior to clinical implementation, an in-depth analysis of the clinical and immunohistopathological effects of tissue adhesives on the target tissue and of the mechanical strength of the adhesive bond in an in vivo model is needed. Materials and methods:In 84 rats, two bowel segments were glued using one of the following tissue adhesive: Bioglue, Gelatin-resorcinol-formaldehyde (GRF), Glubran 2, Histoacryl Flex, Omnex, Duraseal Xact, or Tissucol. Rats were followed for 7 or 28 days. Endpoints were clinical complication rate, mechanical strength, and immunohistopathological reactions. Results: Of the seven tissue adhesives, GRF and Bioglue showed the highest rates of bowel wall destruction and ileus and the most severe immunohistopathological tissue reactions at 7 and 28 days. Cyanoacrylates (Histoacryl Flex, Omnex, Glubran 2) showed high mechanical strength and mild immunohistopathological reactions at 7 and 28 days. Duraseal Xact and Tissucol were the most inert tissue adhesives, but exhibited low mechanical strength. At 28 days, mechanical strength was significantly correlated to CD8, CD68, and Ki67 cell counts. Conclusion: Based on the clinical and immunohistopathological outcomes, GRF and Bioglue were found to be the least suitable tissue adhesives for colonic use. Duraseal Xact and Tissucol were inert but also showed low mechanical strength. Cyanoacrylates exhibited mild clinical and immunohistopathological effects while maintaining high strength, which makes them promising as colonic sealants.

A collaborative review of the current concepts and challenges of anastomotic leaks in colorectal surgery

“…The most recent technology, LifeSeal TM (Life-Bond, Caesarea Industrial Park, Israel), uses enzymebased catalytic breakdown of a gelatin-based product to seal an anastomosis; the results of early-phase clinical trials are awaited. Recent studies in rat models of AL have demonstrated that cyanoacrylate-based adhesives show the greatest mechanical strength and the lowest rate of ileus, bowel wall destruction and immunohistopathological tissue reaction compared with other adhesive materials [37,38]. In a related strategy, omental wrap [39] and mesenteric flap formation [40] have been used to seal anastomoses and provide a cellular scaffold for healing.…”

Tissue reactions to polyethylene glycol and glutaraldehyde-based surgical sealants in a rabbit aorta model

“…30 Furthermore, Vakalopoulos et al reported correlation between tensile strength and markers of inflammation when comparing a variety of different tissue sealants (including BioGlue, but not Coseal). 23 The high compressive modulus of BioGlue indicates that the sealant may limit changes in vessel diameter in response to pulsatile blood flow, whereas the low compressive modulus of Coseal indicates a pliable material allowing natural vascular compliance and rebound.…”

“…These tissues have previously displayed adverse reactions to BioGlue. 17,23,43 One limitation of this study was that a single time point was evaluated; therefore, dynamic progression of the inflammatory response, and its dominant features (e.g. eosinophil infiltration), could not be assessed.…”

“…15,16 Studies have evaluated the response of a variety of different tissue types to BioGlue, with variable results reported in terms of the severity of tissue reaction. [17][18][19][20][21][22][23][24][25][26] Research regarding Coseal suggests that this material may hold chemical and mechanical advantages over BioGlue [26][27][28][29][30] ; however, a head-to-head comparison of the vascular tissue reactions to these two particular materials has not been performed to date. This is despite both sealants being indicated for use as an adjunct to mechanical sealing during repair and/or reconstruction of large blood vessels.…”

Effects of Duraseal® and Fibrin Glue on healing of normal and ischemic colon anastomosis

“…Anastomotic leaks represent a major complication of traditional or laparoscopic colorectal surgery that are associated with increased morbidity, risk of reoperation, prolonged hospitalization, and reduced quality of life (Raptis, Pramateftakis, & Kanellos, 2018). Although the reported rates of anastomotic leaks vary between 1% and 24%, this figure is approximately 5% in experienced centers (McArdle, McMillan, & Hole, 2005;Raptis et al, 2018;;Vakalopoulos et al, 2017b), while it may increase up to 30% to 40% in ischemia, where wound healing is poor, and in patients with inflammatory bowel disease (Wu et al, 2015). Anastomotic leaks following curative surgery for colorectal cancer have been shown to have an adverse impact on the overall survival (McArdle et al, 2005).…”