Staple line reinforcement with nebulized cyanoacrylate glue in laparoscopic sleeve gastrectomy: A propensity score-matched study

Abstract

Background A dreaded complication of laparoscopic sleeve gastrectomy (LSG) is suture leak. The study aimed to assess the efficacy of the nebulized comonomer Glubran 2® (N-butyl-cyanoacrylate + metacrylosysolfolane) applied to the LSG staple line. Methods A propensity-matched comparison analysis was conducted in 125 patients undergoing LSG between 2017 and 2019. Groups included those treated with Glubran® (group 1, n = 70) and those without Glubran® treatment (group 2, n = 55). Results There were differences in the mean body mass index (44.4 vs 43 kg/m2; P < 0.05) between the groups. There was a non-significant increase in the operative time for group 1 compared with group 2 (97 ± 8 vs 93.8 ± 10.7 min; P = 0.07), with a greater amount of estimated blood loss (94.5 mL vs 87.8; P < 0.01). There were more severe complications in group 2 over group 1 cases (8 vs 0%; P < 0.05), although postoperative bleeding did not differ between the two groups (1.4 vs 5.4%). There were no postoperative leaks in group 1 patients, but there were two leaks in group 2 cases with an increased length of hospital stay in patients with a leak. Conclusion Glubran® LSG support may reduce leak risk without increasing operating time.

Endoscopic Management of Post-Sleeve Gastrectomy Complications

“…However, pro-inflammatory effects have been documented [10]. Some studies reported favorable results with modified cyanoacrylate, Glubran ® 2 (GEM Srl, Viareggio, Lucca, Italy), associated with chemical omentopexy [61][62][63]. Intraoperative reinforcement with tissue sealants at the time of the SG has been explored, and some authors conclude a decreased risk of complications including leaks [64,65].…”

Suture reinforcement using a modified cyanoacrylate glue prevents anastomotic leak in colorectal surgery: A prospective multicentre randomised trial.

“…Among the possible options to reinforce and protect anastomosis, cyanoacrylate glue application has signi cantly reduced AL in colon anastomosis in a porcine model [17][18][19][20] and prevents suture leakage after sleeve gastrectomy [21]. Furthermore, cyanoacrylate is widely used in endoscopy for the emergency management of patients with upper gastrointestinal bleeding because of its adhesive and haemostatic seal when nebulised and sprayed on injured tissues [22].…”

“…Furthermore, the sealing effect creates an antiseptic barrier against bacteria [23]. The application of cyanoacrylate glue in vascular surgery [24], urology [25], and bariatric surgery [21] has been previously described.…”