Critical analysis of cyanoacrylate in intestinal and colorectal anastomosis

Wu, Zhi‐Yong; Boersema, Geesien S. A.; Vakalopoulos, Konstantinos A.; Daams, Freek; Sparreboom, Cloë L; Kleinrensink, Gert-Jan; Jeekel, J; Lange, Johan F.

doi:10.1002/jbm.b.33039

Cited by 27 publications

(19 citation statements)

References 30 publications

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“…While it is unclear as to why an increased reaction was seen with synthetic PEG hydrogel (other than the nature of foreign bodies), an increased inflammatory reaction is a common observation with cyanoacrylate. [6,11,12] Notably, increased inflammation was present on the serosal surface of piglet bowel at 14 days compared to 0 days with the BSP, but no comparisons have currently been performed with other sealants or controls. Therefore, it is unknown as of yet if the increased inflammation is consistent with normal healing from a sutured anastomosis or if BSP caused excess inflammation independent to normal intestinal healing.…”

Section: Discussionmentioning

confidence: 99%

“…Use of these products is generally limited to external surfaces due to their rigidity and propensity to cause intense local inflammation. [5,6] A surgical sealant that minimizes all of these problems and could be used internally in the human body may have large-scale clinical impact in improving surgical outcomes and minimizing the occurrence of complications in technically complex procedures such as an anastomosis.…”

Section: Introductionmentioning

confidence: 99%

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Solution blow spun polymer: A novel preclinical surgical sealant for bowel anastomoses

Kern

Behrens

Srinivasan

et al. 2017

Journal of Pediatric Surgery

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Background Solution blow spinning is a technique for depositing polymer fibers with promising potential use as a surgical sealant. This study assessed the feasibility and efficacy of solution blow spun polymer (BSP) for sealing bowel perforations in a mouse model of partial cecal transection. We then evaluated its use for reinforcing a surgical anastomosis in a pre-clinical piglet model. Methods Three commercially available surgical sealants (fibrin glue, polyethylene glycol (PEG) hydrogel, and cyanoacrylate) were compared to BSP in the ability to seal partially transected cecum in mice. For anastomosis feasibility testing in a piglet model, piglets were subjected to small bowel transection with sutured anastomosis reinforced with BSP application. Outcome measures included anastomotic burst pressure, anastomotic leak rate, 14-day survival, and complication rate. Results For the mouse model, the survival rates for the sealants were 30% for fibrin glue, 20% for PEG hydrogel, 78% for cyanoacrylate, and 67% for BSP. Three of 9 mice died after BSP administration due to perforation leak, failure to thrive with partial obstruction at the perforation site, and unknown causes. All other mice died of perforation leak. The mean burst pressure at 24 hours was significantly higher for BSP (81mmHg) when compared to fibrin glue (6mmHg, p=0.047) or PEG hydrogel (10mmHg, p=0.047), and comparable to cyanoacrylate (64mmHg, p=0.91). For piglets, 4 of 4 animals survived at 14 days. Mean burst pressures at time of surgery were 37±5mmHg for BSP and 11±9mmHg for suture-only controls (p=0.09). Conclusions Solution blow spinning may be an effective technique as an adjunct for sealing of gastrointestinal anastomosis. Further preclinical testing is warranted to better understand BSP properties and alternative surgical applications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Solution blow spun polymer: A novel preclinical surgical sealant for bowel anastomoses

Kern

Behrens

Srinivasan

et al. 2017

Journal of Pediatric Surgery

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“…An example is the reported successful use of N-butyl-2-cyanoacrylate for a transcatheter arterial embolization on a 57-year old patient reported to be suffering from pancreatic arteriovenous malformation (125). A recently published paper reviewed published literature studies on the use of various cyanoacrylate monomers in gastrointestinal anastomosis and correlated the methodological aspects with the experimental outcomes (126) and concluded the use of cyanoacrylates in such applications to be very promising.…”

Section: Cyanoacrylates In Medical Applicationsmentioning

confidence: 97%

Polycyanoacrylates

Burns

2016

Encyclopedia of Polymer Science and Technology

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Alkyl 2‐cyanoacrylate monomers are commonly used as instant adhesives or “superglue,” mainly because of their unique ability to undergo rapid polymerization under ambient conditions on a wide range of surfaces. This article overviews the chemistry and physical properties of these materials, the most common methods of preparation, their mode(s) of polymerization, and typical performance properties. The main performance limitations of alkyl 2‐cyanoacrylate adhesives, such as poor hot strength and resistance to extreme environments (high heat and humidity) are explained in terms of the susceptibility of the polymer to degradation, and how the chemical structure of the polymer directly affects this degradation process. An overview is given of how the performance properties of cyanoacrylate adhesives are modified through the inclusion of various thickeners for viscosity modification, accelerators for cure acceleration, and recent advances in two component cyanoacrylate adhesives. The uses of polycyanoacrylates in medical adhesive applications and for the preparation of nanoparticles for drug delivery are briefly reviewed.

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“…However, from a practical point of view, our data, together with the evidence from other animal studies, have revealed the effectiveness and safety of n-butyl-cyanoacrylate as an anastomotic sealant. 30 It seems to be a promising adjuvant in a surgeon's toolbox.…”

Section: Discussionmentioning

confidence: 99%