Use of Fibrin Sealant in Hypospadias Surgical Repair Reduces the Frequency of Postoperative Complications

Abstract

Introduction: Urethrocutaneous fistulas (UCF) and flap dehiscence (FD) are the most common postoperative complications after hypospadias (HS) surgical repair. The aim of this study was to evaluate whether the application of fibrin sealant over the site of surgery and suture lines reduces these complications. Materials and Methods: A prospective cohort of consecutive patients was treated over a 3-year period. 30 patients were submitted to HS surgical repair plus application of fibrin glue over the suture line and surgical site; for comparison, another 56 subjects made up the control group which was submitted to surgical repair only. Variables assessed included: age, type of HS, fibrin sealant used, complications and number of surgical procedures required to treat recurrences. Results: In general, the frequency of complications was 10 vs. 41% for UCF (p = 0.002), 13 vs. 50% for FD (p = 0.001), and for flap necrosis (FN) 6.7 vs. 28.6% (p = 0.01) for the treatment and control groups respectively. The number of surgical reinterventions to treat recurrences was higher in the control group than in the study group (p = 0.04). Conclusion: The incidence of UCF after HS surgical repair can be reduced by applying fibrin sealant over the site of surgery and the suture lines.

Use of BioGlue Surgical Adhesive in Hypospadias Repair

“…The authors clearly demonstrated a shortened overall operative time and a decreased occurrence of the early postoperative leakage. Others however have pointed out that the application of glue in hypospadias repair does not completely eliminate fistula formation, even though it seems that it may minimizes the incidence of fistula formation and flap dehiscence [11,12]. …”

“…Some authors have demonstrated that covering the first suture line with single or double dartos flap or spongioplasty may decrease the incidence of fistula development [5,6,7,8,9]. Others have demonstrated some benefits with the use of fibrin glue as a sealant for urethrocutaneous fistula prevention after hypospadias repair and for the closure of fistulas [10,11,12]. However fibrin sealants from a single-donor or multiple donors have some risks of HCV, HBV or HIV contamination, may sometimes lead to a severe allergic reaction, and are also expensive [13,14].…”

Single-donor fibrin sealant for repair of urethrocutaneous fistulae following multiple hypospadias and epispadias repairs

“…They found out that the rate of fistula formation, postoperative edema and duration of hospitalization were all reduced using Tisseel, the commercially available fibrin glue, on suture lines [5]. Other studies have confirmed the reduction in the incidence of postoperative urethrocutaneous fistula using fibrin glue [17,18]. Fibrin sealants can also be useful in complex anterior and posterior urethral surgeries, when skin or buccal mucosal grafts are used.…”

Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair

“…Hick and Morey [13] used fibrin glue as a sealant to enhance wound healing in penile urethroplasty. Ambriz-González et al [14] concluded that the incidence of urethrocutaneous fistula after hypospadias surgical repair can be reduced by applying fibrin sealant over the site of surgery and the suture lines. Barbagli et al [4] used fibrin glue in bulbar urethroplasty and stated that the use of fibrin glue represents a slight but significant step toward perfecting the surgical technique of bulbar urethral reconstruction using dorsal buccal mucosal graft.…”