The Effect of Fibrin Glue on the Intensity of Colonic Anastomosis in the Presence and Absence of Peritonitis: An Experimental Randomized Controlled Trial on Rats

Abstract

Aim. Anastomotic leakage after colon anastomosis is the most frequent and most feared complication with its highest mortality rate. In this study, we aimed to expose the impact of performing fibrin glue on sutured colocolic anastomosis, in the presence of experimental peritonitis, on anastomosis safety. Method. In this experimental study, the rats were divided into two groups as control group (Groups 1 and 3) and experimental group (Groups 2 and 4). They were also divided as clean abdomen (Groups 1 and 2) and infected abdomen (3 and 4) groups. Full-thickness incisions were made on the proximal colon of both groups of rats. The control group's anastomoses were conducted only with sutures, whereas in experimental group, fibrin glue was applied over the sutures. The samples were taken on the 10th day. Results. Highest values for average levels of hydroxyproline in the tissues and anastomotic bursting pressures were detected when fibrin glue was applied on sutured anastomosis in clean abdomen. In the histopathological staging performed in line with Ehrlich-Hunt model, lowest values were detected during the presence of peritonitis. Conclusion. As a result, it has been established that the use of fibrin glue over sutured colocolic anastomosis, both in clean abdomen and in the presence of peritonitis, had increased anastomosis safety.

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

“…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).…”

“…Among the 28 studies included in the present review, which all focused on both healing and mechanical properties, it appears that the results on these macroscopic/mechanical properties differed considerably from the healing results. A total of 14 studies found a positive effect on anastomotic leakage, anastomotic strength or bursting pressure [55,56,57,58,59,60,61,63,70,75,76,77,78,80], while only 2 studies found a negative effect on these end points [69,71]. 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]. …”

Clinical, mechanical, and immunohistopathological effects of tissue adhesives on the colon: An in‐vivo study

“…Previous studies have primarily focused on the histopathology of FG and CA. Several authors reported promising effects of FG sealing of colonic rat anastomoses in which FG use led to only mild inflammatory reaction and no tissue toxicity . Regarding CA, early studies pointed out that long‐chain CA formulations elicited an exothermic reaction leading to a severe inflammatory tissue response .…”

“…Cyanoacrylates (CA), the largest TA category, are known to form a rigid and watertight bond and have been recently proposed to be potential candidates for the sealing of bowel anastomoses . Fibrin glues (FGs) act as hemostats by enhancing the final stage of the clotting cascade and form a network of fibrin molecules with the adhesive substrate, and have been useful in the sealing of experimental colorectal anastomoses . Polyethylene glycol adhesives (PEGs) are flexible hydrogels, primarily used in neurosurgery for sealing the Dura mater .…”