The potential effect of biological sealants on colorectal anastomosis healing in experimental research involving severe diabetes

Abstract

Colorectal anastomoses continuous to pose a significant challenge in current surgical practice. Anastomotic leakage remains one of the most frequent and dramatic complications of colorectal surgery, even in centres of high specialisation. Diabetes is a well-established independent factor which results in higher anastomotic leakage rates. Fibrin sealants have been applied in experimental and clinical studies for the prevention of anastomotic dehiscence. However, little is known regarding their impact on diabetic patients. Several fibrin sealants have been proposed as adjunct to standard surgical techniques to prevent leakage from colonic anastomoses following the reversal of temporary colostomies, approved for general haemostasis. This review summarises current advances in colorectal anastomoses and provides evidence that may strengthen the need for tissue sealants in colorectal anastomoses of diabetic patients. We searched Medline (1966-2016) and Scopus (2004-2016) for current evidence in the field. To date, there is no evidence to support the use of fibrin sealants as an adjunct in diabetic patients who undergo colorectal surgery. Experimental animal models with extreme diabetes could be of significant use in the present field and further research is needed prior to application of fibrin sealants in a clinical setting.

How to Prevent Anastomotic Leak in Colorectal Surgery? A Systematic Review

“…The predictive factors related to the patient were divided into 2 categories: nonmodifiable factors and modifiable factors. Several reviews [3,[9][10][11][12][13][14][15] were interested in identifying these essential factors: male sex [3,[9][10][11][12][13][14], ASA physical status classification > II [3,9,11,14], alcohol and tobacco use [3,12], associated comorbidities [3,14,15], obesity [3,[11][12][13], malnutrition [3,9], hypoalbu-min [9], steroid and nonsteroid anti-inflammatory use [3,9,14], neoadjuvant radiotherapy [3,10], neoadjuvant chemotherapy [11][12][13], bevacizumab use [9,12], advanced stage of the tumor [3,11,13] the distal localization of rectal tumor [3,[9]…”

Rectal application of argan oil improves healing of colorectal anastomosis in rats

“…However, experienced and specialized colorectal surgeons have confirmed leakage rates of between 3% and 6% as acceptable. It is generally accepted that emergent operations have a greater risk of the breakdown of anastomosis than elective procedures 1,2 . Although several studies have been conducted over the years, not only for the development of new surgical techniques but also to evaluate the use of some locally applied or systemic products, there is still no widely accepted treatment method for the prevention of anastomotic leakage.…”

Rat models of high risk colorectal anastomoses

“…Treatment of high-risk colorectal anastomosis associated with intestinal leakage is still a challenge. The impact of anastomotic dehiscence on patient morbidity and quality of life is devastating, even when it is detected within the limit of 60 minutes, since such situation usually leads to fecal peritonitis and uncontrollable sepsis 1 . Many aspects including age, nourishment state, type and duration of disease, local and systemic conditions, use of some drugs, for instance, may influence how to handle properly those complications.…”