Effects of TachoSil and 5-fluorouracil on colonic anastomotic healing

Sabino, Flávio; Campos, Carlos Frederico Ferreira; Caetano, Carlos Henrique Soares; Trotte, Marcele Nogueira S.; Oliveira, Albanita V.; Marques, Ruy Garcia

doi:10.1016/j.jss.2014.05.067

Cited by 10 publications

(9 citation statements)

References 52 publications

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“…The application of a fibrinogen and thrombin patch over colonic anastomoses is a relatively new idea[ 7 ]. Some authors[ 19 , 20 ] used the classical cecal puncture model to define high-risk anastomosis, thereby providing the sepsis model[ 20 - 24 ]. To date, there has not been any consensus regarding the definition of high-risk anastomosis and, to our knowledge, there have been few studies that have examined the application of TachoSil ® over colonic anastomoses[ 7 - 10 , 20 - 24 ], with only one carried out using a high-risk anastomosis[ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some authors[ 19 , 20 ] used the classical cecal puncture model to define high-risk anastomosis, thereby providing the sepsis model[ 20 - 24 ]. To date, there has not been any consensus regarding the definition of high-risk anastomosis and, to our knowledge, there have been few studies that have examined the application of TachoSil ® over colonic anastomoses[ 7 - 10 , 20 - 24 ], with only one carried out using a high-risk anastomosis[ 10 ]. Although these studies showed the method to be safe and feasible, some results have been controversial; Ozel et al[ 7 ] showed that this product increased the inflammatory reaction and led to a worsened healing process with less mechanical strength.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we noted an evident reduction of anastomotic leakage incidences (31.7% vs 21.4% in control and TachoSil ® groups, respectively), but these differences were not significant ( P = 0.29). Even when a potentially injurious agent such as 5-fluorouracil is used, it has been verified that applying anastomosis TachoSil ® confers greater resistance by acting as a protective agent[ 24 ]. In a study using mice, Pantelis et al[ 10 ] achieved a statistically significant difference in the lethality and leakage rates in the group that received TachoSil ® , as well as finding that its use did not increase the formation of intra-abdominal adhesions.…”

Section: Discussionmentioning

confidence: 99%

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Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats

Suárez-Grau¹,

Franco²,

García³

et al. 2016

WJGS

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AIMTo evaluate the effectiveness of human fibrinogen-thrombin collagen patch (TachoSil®) in the reinforcement of high-risk colon anastomoses.METHODSA quasi-experimental study was conducted in Wistar rats (n = 56) that all underwent high-risk anastomoses (anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group (24 rats) and treatment group (24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil® (a piece of TachoSil® was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes.RESULTSOverall survival was 71.4% and 57.14% in the TachoSil® group and control group, respectively (P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage (P > 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups (P = 0.066).CONCLUSIONIn our study, the use of TachoSil® was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil® has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats

Suárez-Grau¹,

Franco²,

García³

et al. 2016

WJGS

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“…For example, the Seamguard (Gore, Newark, US) staple line reinforcement is a bioabsorbable laminar matrix consisting of polyglycolic acid and trimethylene carbonate, which is stapled between the intestinal layers for mechanical buttressing. There are some clinical studies of poor quality, mainly focusing on the use in gastric/bariatric and less in colorectal anastomoses [53][54][55][56][57][58][59]. Although it was safe and feasible in those studies, no consistent positive effect on anastomotic healing could be determined so far [56,58,60].…”

Section: Staple Line Reinforcementmentioning

confidence: 99%

Innovative approaches for induction of gastrointestinal anastomotic healing: an update on experimental and clinical aspects

Reischl

Wilhelm

Frieß

2020

Langenbecks Arch Surg

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Purpose In most cases, traditional techniques to perform an anastomosis following gastrointestinal resections lead to successful healing. However, despite focused research in the field, in certain high-risk situations leakage rates remain almost unchanged. Here, additional techniques may help the surgeon to protect the anastomosis and prevent leakage. We give an overview of some of the latest developments on experimental and clinical techniques for induction of anastomotic healing. Methods We performed a review of the current literature on approaches to improve anastomotic healing. Results Many promising approaches with a high clinical potential are in the developmental pipeline. Highly experimental approaches like inhibition of matrix metalloproteinases, stem cell therapy, hyperbaric oxygen therapy, induction of the hypoxic adaptive response, and the administration of growth factors are still in the preclinical phase. Other more clinical developments aim to strengthen the anastomotic suture line mechanically while shielding it from the influence of the microbiome. Among them are gluing, seaming the staple line, attachment of laminar biomaterials, and temporary intraluminal tubes. In addition, individualized bowel preparation, selectively reducing certain detrimental microbial populations could become the next stage of bowel preparation. Compression anastomoses are evolving as an equivalent technique additional to established hand-sewn and stapled anastomoses. Fluorescence angiography and flexible endoscopy could complement intraoperative quality control additionally to the air leak tests. Virtual ileostomy is a concept to prepare the bowel for the easy formation of a stoma in case of leakage. Conclusion A variety of promising diagnostic and prophylactic measures that may support the surgeon in identifying high-risk anastomoses and support them according to their potential deficits is currently in development.

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“…Of upmost importance is leak prevention in the case of anastomoses at risk of abnormal healing, e.g. with concurrent chemotherapy [76], narrow lumen [77] or even in perforation treatment [78]. The authors of those studies emphasize the safety of collagen sponges covered with fibrinogen and thrombin [79] and their simple use [80].…”

Section: -Application Of Medical Adhesivesmentioning

confidence: 99%

Anastomotic leaks in gastrointestinal surgery and their prevention

Banasiewicz¹,

Dziki²,

Lampe

et al. 2017

Pol Przegl Chir

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Anastomotic leak in the gastrointestinal tract is one of the most important complications of resection. They are the main cause of reoperation, their occurrence worsens the prognosis of the patient, increasing the proportion of direct mortality, as well as being a significant risk factor for recurrence of cancer. The risk of leaks within the gastrointestinal tract is greatly varied, depending on the location and extent of the resection, but also on patient, disease or a surgical procedure, including surgeon. To determine the potential risk of leakage can be significant for introduction some prophylactic actions. Some of them have the character of general recommendations, as proper nutrition of the patient in the perioperative period, while another part is directly connected to the surgical procedure. The second group includes protective stoma, the use of tissue glues, insertion transrectal drain for rectal anastomosis decompression, the use of stents or the use of collagen matrix coated with fibrinogen and thrombin. Important to reduce the proportion of leaks can be more precise and targeted prophylactic recommendations, based on the individualized determination of risk factors leaks. Further research for this purpose are necessary for this purpose, the big hope can be associated with data obtained through mobile applications.

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Effects of TachoSil and 5-fluorouracil on colonic anastomotic healing

Cited by 10 publications

References 52 publications

Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats

Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats

Innovative approaches for induction of gastrointestinal anastomotic healing: an update on experimental and clinical aspects

Anastomotic leaks in gastrointestinal surgery and their prevention

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