Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant

Ávalos-González, Jorge; Portilla-deBuen, Eliseo; Leal-Cortés, Caridad; Orozco-Mosqueda, Abel; Estrada-Aguilar, María del Carmen; Velazquez-Ramirez, Gabriela; Ambriz-González, Gabriela; Guzmán-Gurrola, Aldo Emmerson; González-Ojeda, Alejandro

doi:10.3748/wjg.v16.i22.2793

Cited by 43 publications

(23 citation statements)

References 39 publications

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“…Avalos-González et al [40] reported that a fibrin sealant could reduce the closure time of stable enterocutaneous fistulas. The AFP, which is made of lyophilized porcine intestinal submucosa, has the same effect on an anal fistula.…”

Section: Discussionmentioning

confidence: 99%

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

Jin²

2012

WJGS

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AIM:To investigate the efficacy of the anal fistula plug (AFP) compared to the mucosa advancement flap (MAF), considered the best procedure for patients with a complex anal fistula. METHODS:The literature search included PubMed, EMBASE, Cochrane Library and OVID original studies on the topic of AFP compared to MAF for complex fistula-in-ano that had a deadline for publication by April 2011. Randomized controlled trials, controlled clinical trials and prospective cohort studies were included in the review. After information collection, a meta-analysis was performed using data on overall success rates as well as incidence of incontinence and morbidity. The quality of postoperative life was also included with the clinical results. RESULTS:Six studies involving 408 patients (AFP = 167, MAF = 241) were included in the meta-analysis. The differences in the overall success rates and incidence of fistula recurrence were not statistically significant between the AFP and MAF [risk difference (RD) = -0.12, 95%CI: -0.39 -0.14; RD = 0.13; 95%CI: -0.18 -0.43, respectively]. However, for the AFP, the risk of postoperative impaired continence was lower (RD = -0.08, 95%CI: -0.15 --0.02) as was the incidence of other complications (RD = -0.06, 95%CI: -0.11 --0.00). The postoperative quality of life, for patients treated using the AFP was superior to that of the MAF patients. Patients treated with the AFP had less persistent pain of a shorter duration and the healing time of the fistula and hospital stay were also reduced. CONCLUSION:The AFP is an effective procedure for patients with a complex anal fistula; it has the same success rate but a lower risk of complications than the MAF and may also be associated with an improved postoperative quality of life. Additional evidence is needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

Jin²

2012

WJGS

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“…One of them is adjuvant treatment to achieve hemostasis in diffuse bleeding and to achieve tissue sealing and/or adhesion in surgical treatment. In this regard, fibrin-based biological adhesive is being used in clinical practice by many gastrointestinal surgeons to prevent fistula formation in gastrointestinal anastomoses, achieving a high percentage of success in a short period of time [6,7].…”

Section: Introductionmentioning

confidence: 99%

The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs

Oliver¹,

Garijo²,

Estéves³

et al. 2015

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Abstract:Objective: To analyse hospital costs in the pre-, and intra-and post-operative periods associated with patients undergoing rectal resection with anastomosis, comparing the costs per patient with and without the use of fibrin-based biological adhesive(Tissucol Duo ® ). Methods: The cost analysis was designed with a subsample of 37 patients who underwent rectal anastomosis in a randomised, single-blind, controlled, parallel comparison between two groups, to evaluate the effectiveness of fibrin-based biological adhesive used to prevent anastomotic leakage. The total costs included diagnostic tests, laboratory tests, hospital stay, adhesive cost, surgery, reintervention and drug treatment. Results: The patients had a mean age of 64.33 years, with a higher proportion of men (62.2%). The study groups were homogeneous and comparable. The average total cost in the group with biological adhesive was€ 10,304.84 compared to € 17,845.12 in the group without biological adhesive. Significant differences were found in the average cost of reintervention between groups: € 119.76 with adhesive vs. € 639.20 for the control group. Conclusions: The total cost decreased by 42% in the group in which a biological adhesive was applied compared to the group in which the adhesive was not applied. This percentage represented a difference of € 7,540.28 in the total average cost per patient.

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“…One of the identified studies was for pancreaticoduodenectomy, 28 and one was for esophagojejunal anastomosis, 18 while the other 16 studies were for different procedures in the upper colorectum, including anal fistula repairs and laparoscopic gastric bypass surgeries. 1,2,7,10,[13][14][15][16]19,26,27,32,36,37,40,41,44 Many of these studies suggest a relationship between FS and a reduction in leakages and other complications such as bleeding. However, these studies were not powered to find statistical significance in results.…”

Section: Discussionmentioning

confidence: 99%

<p>Costs Analysis of Fibrin Sealant for Prevention of Anastomotic Leakage in Lower Colorectal Surgery</p>

Panda

Connolly²,

Ramírez³

et al. 2020

RMHP

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Introduction: Postoperative anastomotic leaks remain a common and serious complication of colorectal surgeries and are a major cause of mortality and morbidity of these procedures. Anastomotic leaks (AL) have been extensively studied; however, there has been no significant reduction in their prevalence over time. In addition, there is a significant economic burden from AL attributed to the need for repeat surgery, radiologic intervention and lengthened hospital stay. We conducted a comparative cost analysis of patients undergoing colorectal surgery with anastomosis, with the application of fibrin sealant (FS) to the sutured anastomosis versus not treating the sutured anastomosis with FS. Methods: The deterministic decision-tree model was populated with clinical data including operating room time, hospitalization days, occurrence of AL, need for revision surgery, blood products and radiologic interventions to treat the AL in lower colorectal surgery. A systematic literature review was conducted to identify appropriate studies with these variables. Results: The average cost per case treated lower colorectal surgery with fibrin sealant glue 10 mL Tisseel ® and those not treated with a fibrin sealant after suturing the anastomoses was €3233 and €4130, respectively, for resource expenses paid by the healthcare system. This would suggest potential savings of €897 per surgery, achieved through the application of FS to the sutured anastomosis for preventing AL following colorectal surgery. Conclusion: Application of FS to the sutured anastomosis in lower colorectal surgery resulted in a decrease in post-operative AL, and cost savings based on a reduction in hospitalization days, a reduction needing: revision surgery, radiologic intervention and blood products to treat AL.

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Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant

Abstract: Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.

Cited by 43 publications

References 39 publications

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

Anal fistula plug vs mucosa advancement flap in complex fistula-in-ano: A meta-analysis

The Systematic Use of Fibrin-Based Biological Adhesive to Prevent Leakage Due to Healing Defects in Rectal Anastomosis Significantly Reduces Costs

<p>Costs Analysis of Fibrin Sealant for Prevention of Anastomotic Leakage in Lower Colorectal Surgery</p>

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