Healing of ischemic colonic anastomosis

Abstract

Fibrin adhesives have been advocated as a protective sealant in high-risk colonic anastomoses to prevent leakage. To assess the effect of fibrin glue sealing on the healing ischemic anastomosis, we compared the healing of sutured colonic anastomoses in the rat, with and without fibrin adhesive (Groups IA and IB), and ischemic anastomoses with and without fibrin adhesive (Groups IIA and IIB). On days two, four, and seven, 10 animals in each group were sacrificed. Adhesion formation was scored, and the in situ bursting pressure was measured. The collagen concentration and degradation were estimated by measuring hydroxyproline. Adhesion formation was more prominent in Groups IB, IIA, and IIB on day four only; abscesses were noted in the ischemic group in four rats. Anastomotic bursting pressure was significantly lower in sealed (IB) and ischemic anastomoses (IIA) than in normal anastomoses (IA) on day four. Sealing of ischemic anastomoses did not change bursting pressures on days two, four, and seven. The relative decrease of collagen in the sealed anastomoses is significantly higher on day four only. It is concluded that sealing of normal colonic anastomoses in the rat has a negative effect on wound healing. Ischemia at the anastomotic site results in weaker anastomotic strength on day four postoperatively. Also in ischemic anastomoses, fibrin sealant does not improve wound healing during the first seven days. Adhesion formation on ischemic intestinal anastomoses was not prevented by fibrin sealing.

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

“…Of the 8 studies with no effect on healing, 6 studies revealed a positive effect on bursting pressure or anastomotic strength [70,75,76,77,78,80]. Similar findings were seen in the group of studies reporting a negative effect on healing, where 1 study found a positive effect on bursting pressure and anastomotic strength [63], 6 studies found no effect on these mechanical end points [62,64,65,66,67,68] and only 1 study found a negative effect on bursting pressure [69]. On the contrary, all of the 7 studies that reported a positive effect on healing also showed a positive effect on the mechanical end points [55,56,57,58,59,60,61].…”

“…In 7 of the 28 studies, a positive effect of FG on healing was found [55,56,57,58,59,60,61], while 8 studies reported a negative effect [62,63,64,65,66,67,68,69] and 11 studies found no effect [54,70,71,72,73,74,75,76,77,78,79]. Furthermore, 2 studies reported unclear results [80,81] (table 2).…”

“…Unfortunately, many of these attempts have failed to show convincing results [18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48]. Numerous studies have reported on the sealing of gastrointestinal anastomoses with fibrin glue (FG), also called fibrin sealant.…”

Choosing the Best Animal Species to Mimic Clinical Colon Anastomotic Leakage in Humans: A Qualitative Systematic Review

“…This simulates both the clinical situation with a defect in the stapler line or an insufficiently handsewn anastomosis. Ischemia is created by devascularizing the anastomotic edges by removing mesenteric vessels [24]. This is a good approximation to the clinical situation where removal of mesentery is often necessary for mobilization of the intestine, or where insufficient blood flow for other reasons may contribute to local ischemia.…”

“…Despite the anastomotic bursting pressure being almost 0 for the incomplete anastomoses, no leakage of the colonic content occurred to cause peritonitis. Evaluating ischemia of the rat anastomosis, the same authors created a model by coagulating 2 cm of mesenteric vessels on each side of the anastomosis and thereby compromising blood supply [24]. The anastomosis was created with 12 interrupted nonabsorbable sutures and the same level of the colon as in the previous study was used.…”