Sealing effect of fibrin glue on the healing of gastrointestinal anastomoses: implications for the endoscopic treatment of leaks
- 11 October 2004
- journal article
- Published by Springer Science and Business Media LLC in Surgical Endoscopy
- Vol. 18 (11), 1620-1624
- https://doi.org/10.1007/s00464-004-8803-3
Abstract
The adoption of advanced laparoscopic techniques for complex surgical procedures has raised the concern that the leak rate might be higher than for open surgery, particularly in the surgeon's early experience or in difficult cases. In this study, the sealing effect of fibrin glue on leaking gastrointestinal anastomoses was evaluated in an experimental swine model. A standardized gastrojejunostomy was performed on 20 female pigs (mean weight, 47.7 ± 5.7 kg). A leak was created on the anterior surface of the anastomosis. The animals were randomized to either fibrin glue or no treatment of the leak. Clinical conditions and vital signs, including body temperature, heart rate and, respiratory rate, were collected three times a day. Preoperative and postoperative complete and differential blood count and lactate dehydrogenase levels were determined. Postmortem analysis was performed when the animals were killed. Clinical signs of peritonitis developed in the control animals by the second or third postoperative day. Findings that confirmed the presence of an anastomotic leak at the postmortem examination were the presence of food or gastrojejunal juices in the abdominal cavity, a localized abscess, or a positive air leak test. Fibrin glue treatment prevented the development of peritonitis in all the animals. Complete sealing of the leak was observed on postoperative day 7 in all treated animals, except one in which an asymptomatic contained leak developed. The postoperative total white blood count was significantly increased in the untreated group (24.69 ± 5.5 vs 12.74 ± 3.7 103/ul p < 0.001, paired t-test), as compared with the treated group (15. 55 ± 2.4 vs 14.89 ± 2.7 103/ul; p = 0.24). In this study, fibrin glue showed reproducible sealing effects on leaking gastrojejunal anastomoses. Fibrin glue application may be a valuable approach for the treatment of gastrointestinal anastomotic leaks.Keywords
This publication has 20 references indexed in Scilit:
- Laparoscopic Era of Operations for Morbid ObesityArchives of Surgery, 2003
- Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesitySurgical Endoscopy, 2003
- Suture support: Is it advantageous?The American Journal of Surgery, 2001
- Laparoscopic Roux-en-Y Gastric Bypass for Morbid ObesityArchives of Surgery, 2000
- Malignant esophageal fistulas and perforations: management with plastic-covered metallic endoprostheses.Radiology, 1997
- Upper gastrointestinal tract fistulae: endoscopic obliteration with fibrin sealantGastrointestinal Endoscopy, 1996
- Controlled clinical studies of fibrin sealant in cardiothoracic surgery — a reviewEuropean Journal of Cardio-Thoracic Surgery, 1996
- Fibrin sealant reduces suture line bleeding during carotid endarterectomy: A randomised trialEuropean Journal of Vascular and Endovascular Surgery, 1995
- Four years' experience with fibrin sealant in thoracic and cardiovascular surgeryThe Annals of Thoracic Surgery, 1990
- Effect of a biologic glue on the leakage rate of experimental rectal anastomosesThe American Journal of Surgery, 1982