Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

Nordentoft, Tyge; Pommergaard, Hans-Christian; Rosenberg, Jacob; Achiam, Michael Patrick

doi:10.1159/000366418

Cited by 41 publications

(32 citation statements)

References 76 publications

(119 reference statements)

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“…In the second study the usage of the same material on a colonic anastomosis showed notable reduction of anastomotic leakage 47 . However, when it comes to clinical use of this material, the fibrin glue does not seem to promote healing as the same authors stated in their review article including 28 studies, only 7 of which revealed a positive effect of the glue 48 . Recently, a clinical study was designed to determine the effect of TachoSil patch in human patients 12 .…”

Section: Discussionmentioning

confidence: 84%

Experimental fortification of intestinal anastomoses with nanofibrous materials in a large animal model

Rosendorf

Horakova

Klicova

et al. 2020

Sci Rep

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Anastomotic leakage is a severe complication in gastrointestinal surgery. It is often a reason for reoperation together with intestinal passage blockage due to formation of peritoneal adhesions. Different materials as local prevention of these complications have been studied, none of which are nowadays routinely used in clinical practice. Nanofabrics created proved to promote healing with their structure similar to extracellular matrix. We decided to study their impact on anastomotic healing and formation of peritoneal adhesions. We performed an experiment on 24 piglets. We constructed 3 hand sutured end-to-end anastomoses on the small intestine of each pig. We covered the anastomoses with a sheet of polycaprolactone nanomaterial in the first experimental group, with a sheet of copolymer of polylactic acid with polycaprolactone in the second one and no fortifying material was used in the Control group. The animals were sacrificed after 3 weeks of observation. Clinical, biochemical and macroscopic signs of anastomotic leakage or intestinal obstruction were monitored, the quality of the scar tissue was assessed histologically, and a newly developed scoring system was employed to evaluate the presence of adhesions. The material is easy to manipulate with. There was no mortality or major morbidity in our groups. No statistical difference was found inbetween the groups in the matter of level of peritoneal adhesions or the quality of the anastomoses. We created a new adhesion scoring system. The material appears to be safe however needs to be studied further to prove itsʹ positive effects.

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“…In addition, a previous systematic review produced by the same study group, has revealed that application of fibrin sealants on colonic defects is promising (24). However, the most recent systematic review relevant to this field failed to show a clear benefit from the use of fibrin glue on colorectal anastomoses (25). in vivo 34: 659-665 (2020) 662 Table II.…”

Section: Discussionmentioning

confidence: 99%

The Effect of TISSEEL® on Colorectal Anastomosis Healing Process in a Diabetic Animal Experimental Model

Stergios¹,

Frountzas²,

Pergialiotis³

et al. 2020

In Vivo

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Background/Aim: Diabetes mellitus is an established risk factor of colorectal anastomosis failure. The purpose of the present study was to evaluate the effect of TISSEEL ® in anastomotic healing. Materials and Methods: Forty male, Sprague-Dawley rats were used. Diabetes was induced in half of them by intraperitoneal injection of Streptozotocin, 60 mg/kg. One week after the injection, animals were operated and a 1 cm segment was removed and an end-to-end hand sewn anastomosis was performed. TISSEEL ® was applied in each group (diabetic, non-diabetic) following randomization. Results: The pathology analysis revealed improved tissue remodeling in the TISSEEL ® group, both for the normoglycemic and the diabetic group. Specifically, the extent of inflammation was decreased (p<0.001), whereas fibroblast and collagen formation were improved (p=0.040 and p=0.008). Neovascularization was also improved (p=0.047). Conclusion: Application of TISSEEL ® on colorectal anastomoses improves healing in rats that suffer from severe hyperglycemia.Surgical operation is currently the definitive treatment option both for colorectal cancer and a variety of benign colorectal modalities, such as inflammatory bowel disease (IBD), inflammatory strictures, diverticulosis-diverticulitis, obstructive defecation, volvulus, fistulae etc. (1). Despite the fact that 659

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“…The results of studies regarding the efficacy of medical adhesives are equivocal, and in recent reviews, the ambiguity of the effectiveness and practical usefulness of medical adhesives has been emphasized; the positive effect can be attributed to strengthening the anastomosis rather than influencing healing [54], which has been confirmed by pathology studies of anastomoses in experimental models [54]. In the literature, there are reports of an increased risk of anastomotic stricture after application of acrylic adhesives, which can strongly influence therapeutic outcomes [55].…”

Section: Prevention Of Intestinal Anastomotic Leak -Current Methodsmentioning

confidence: 99%

Anastomotic leaks in gastrointestinal surgery and their prevention

Banasiewicz¹,

Dziki²,

Lampe³

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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“…21 Previous systematic reviews failed to show a clear benefit of the application of glue on the colorectal anastomosis. 28 New sealants with a licence to be used in colorectal anastomosis have not so far been tested in animal models or, more importantly, in animal models of severe diabetes.…”

Section: The Rationale For Colorectal Anastomosis In a Diabetic Animamentioning

confidence: 99%

The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes

Stergios

Kontzoglou

Pergialiotis

et al. 2017

annals

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Colorectal anastomoses continuous to pose a significant challenge in current surgical practice. Anastomotic leakage remains one of the most frequent and dramatic complications of colorectal surgery, even in centres of high specialisation. Diabetes is a well-established independent factor which results in higher anastomotic leakage rates. Fibrin sealants have been applied in experimental and clinical studies for the prevention of anastomotic dehiscence. However, little is known regarding their impact on diabetic patients. Several fibrin sealants have been proposed as adjunct to standard surgical techniques to prevent leakage from colonic anastomoses following the reversal of temporary colostomies, approved for general haemostasis. This review summarises current advances in colorectal anastomoses and provides evidence that may strengthen the need for tissue sealants in colorectal anastomoses of diabetic patients. We searched Medline (1966-2016) and Scopus (2004-2016) for current evidence in the field. To date, there is no evidence to support the use of fibrin sealants as an adjunct in diabetic patients who undergo colorectal surgery. Experimental animal models with extreme diabetes could be of significant use in the present field and further research is needed prior to application of fibrin sealants in a clinical setting.

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“…In the current study, the effect of FG for sealing gastrointestinal defect is still plausible, which may only play the temporary sealing effect. [ 5 ] The OverStitch Endoscopic Suturing System is a suturing device which can achieve full-thickness surgical suturing delivered through a double-channel endoscope. However, an animal study found that the average suture time was 1 h for seasoned experts, which indicated the technical difficulty of the OverStitch Endoscopic Suturing System.…”

mentioning

confidence: 99%

Complete Closure of Gastric Defect with Improved Purse-String Suture Technique Using Single-Channel Endoscope

Lin

Wang

et al. 2018

Chinese Medical Journal

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Fibrin Glue Does Not Improve Healing of Gastrointestinal Anastomoses: A Systematic Review

Cited by 41 publications

References 76 publications

Experimental fortification of intestinal anastomoses with nanofibrous materials in a large animal model

The Effect of TISSEEL® on Colorectal Anastomosis Healing Process in a Diabetic Animal Experimental Model

Anastomotic leaks in gastrointestinal surgery and their prevention

The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes

Complete Closure of Gastric Defect with Improved Purse-String Suture Technique Using Single-Channel Endoscope

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