Sutureless and Reduced Suture Anastomosis of Hollow Vessels With Fibrin Glue: A Review

Abstract

Research in reduced suture fibrin glue (FG) and sutureless FG anastomosis has been lagging behind FG utilization in other surgical fields. A review of the literature for vascular, esophageal, tracheal, gastrointestinal, common bile duct, ureteral, vas deferens, and Fallopian tube FG anastomosis indicates that reduced suture FG and sutureless FG procedures may be performed with less training, reduced operating time, leakage, ischemia, inflammation, and necrosis compared to sutured techniques. Reduced suture FG vascular anastomosis augments early anastomotic strength. Suture number for esophageal, tracheal, and tracheobronchial anastomoses can be reduced with FG. Bursting strength in pig small intestine and rat colon was lower at 4 days postoperatively, but returned to sutured strength at 7 days. Mortality was unaffected, and 18-month follow-up in sutureless FG intestinal anastomosis in pigs showed no stenosis. Preliminary ureteral studies have demonstrated successful sutureless FG and reduced suture FG laparoscopic techniques in pigs. Reduced suture FG and sutureless FG vas deferens anastomosis may reduce sperm granuloma rates, with increased patency and pregnancy rates. Patency and pregnancy rates have been similar for tubal FG, reduced suture FG, autologous fibrin glue (AFG), and sutured anastomosis. Any risk of viral transmission or immune response is eliminated by AFG. While there are few studies in many areas of FG hollow vessel anastomosis, the current literature illustrates many of the advantages of FG over other anastomotic techniques and should provide impetus for continued research in this promising field of surgery.

Early effects of fibrin sealant on colonic anastomosis in rats: an experimental and case-control study

“…Ascheri et al [32] observed that, when compared to the control group, the fibrin sealant group had significantly higher bursting pressures throughout the first 24 hours, whereas they were similar on days 5 and 7. Detweiler et al [33] reported that bursting pressures were significantly lower in the group in which fibrin sealant was used around ileal and colonic anostomoses on day 4. They also reported that fibrin sealant reduced the channel of the anostomosis.…”

The use of autologous platelet–leukocyte gels to enhance the healing process in surgery, a review

“…In the past, fibrin glues have been used to make a sutureless intestine anastomosis and to treat gastrointestinal anastomotic leaks during laparoscopic surgery [30,31].…”

Sutureless Pancreatojejunal Anastomosis Using an Absorbable Sealant: Evaluation in a Pig Model

“…Reduced operating time, simplicity of use, and lower leakage rates have been proposed as advantages of sutureless fibrin glue procedures [11]. However, although fibrin glue has been successful in constructing various kinds of intestinal anastomoses [12], its use has been associated with reduced blood supply to the anastomosis [11,13], a fact that may affect normal anastomotic healing. As an alternative to fibrin glue, Sweeney et al [13], proposed the use of the biodegradable, hydrogel sealant Focalseal for the construction of sutureless small bowel anastomosis.…”

“…The concept of sutureless anastomosis of hollow viscus with the aid of surgical sealants has been investigated in a number of experimental studies, most of which used fibrin glue [11]. Reduced operating time, simplicity of use, and lower leakage rates have been proposed as advantages of sutureless fibrin glue procedures [11].…”