The efficacy and side effects of gelatin-resorcinol formaldehyde-glutaraldehyde (GRFG) glue for preventing and sealing pulmonary air leakage

Abstract

This study was conducted to examine the efficacy and side effects of gelatin-resorcinol formaldehyde-glutaraldehyde (GRFG) glue, when used for preventing or sealing pulmonary air leakage during lung surgery. Formaldehyde-glutaraldehyde (FG) jelly was prepared by mixing FG fluid with 2.5% carboxymethyl cellulose to increase its viscosity. A GRFG glue-spreading stapler was employed to prevent air leakage from the staple line when cutting emphysematous lung tissue in 26 patients, 25 of whom underwent video-assisted thoracoscopic surgery (VATS) and 1, open thoracotomy. A glue-sealing procedure was employed to stop existing pulmonary air leakage in a further 36 patients, 28 of whom underwent VATS and 8, open thoracotomy. The glue-spreading stapler technique prevented air leakage in all 26 patients (100%), while the glue-sealing procedure for pulmonary air leakage stopped air leakage in 31 of the 36 patients (86%). Two patients who underwent glue sealing for air leakage from a deeply cut lung surface suffered massive pulmonary air leakage on postoperative day (POD) 1 and 6, respectively, and required repeat surgery to suture the lung fistula. A transient fever of 38 degrees-39 degrees developed on POD 7 in 6 of the 62 patients (9.7%), but no other complications were observed. These results demonstrated that GRFG is safe and effective in preventing or stopping pulmonary air leakage in the peripheral lung, but not for stopping air leakage from a deeply cut lung.

Elastic sealants for surgical applications

“…Resorcinol was also added to increase the adhesion strength, resulting in the so-called gelatin-resorcinol-formaldehyde (GRF) recipe [39]. Due to the well know toxicity of formaldehyde, glutaraldehyde was later added to the gelatin sealant as the crosslinker, known as the gelatin-resorcinol-formaldehyde-glutaraldehye (GRFG) glue [39–41]. Mechanisms for the covalent bonds formation in these gelatin-based sealants are quite complicated.…”

“…(A) Ru-catalyzed visible light promoted reaction to chemically crosslink tyrosine-containing proteins and polypeptides via the formation of dityrosine linkages [30]. (B) Crosslinking mechanism of GRF or GRFG sealants, including (i) the reaction between lysine residues and formaldehyde, (ii) Schiff base formation between lysine residues and glutaraldehyde, and (iii) formation of the network structure from formaldehyde and resorcinol [39–41]. (C) Reaction between NHS-activated poly(L-glutamic acid) and gelatin [42].…”

Enhanced Sealing by Hydrophobic Modification of Alaska Pollock‐Derived Gelatin‐Based Surgical Sealants for the Treatment of Pulmonary Air Leaks

“…[2] To solve these problems, in recent years, surgical sealants have been used in addition to sutures and staples.Currently used surgical sealants include fibrin-, [3] urethane-, [4] and cyanoacrylate-based sealants. [5] In addition, surgical sealants composed of natural and synthetic polymers have been developed, such as biopolymeraldehyde- [6] and human serum albumin-polyethylene glycol-based sealants. [7] However, these sealants have disadvantages in terms of bonding/sealing strength, biocompatibility, and biodegradation.…”

Therapeutic Effects of Gelatin-Resorcin-Formal Glue in the Treatment of Postoperative Fistula Following a Low Anterior Resection: Report of a Case

“…This mixture has been used mainly in surgery for aortic dissection and respiratory tract surgery. [2][3][4] Several published reports of using GRF glue during surgery have indicated that this agent is very useful in providing excellent adhesion and hemostasis. However, GRF glue has not been used for digestive tract surgery compared with fibrin glue.…”