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Cyanoacrylate for colonic anastomosis; is it safe?

  • Ki-Beom Bae
  • Sun-Hee Kim
  • Soo-Jin Jung
  • Kwan-Hee HongEmail author
Original Article

Abstract

Background

This experimental study evaluated the effectiveness and safety of using cyanoacrylate adhesive for sutureless colonic anastomosis and as a protective seal to prevent leakage.

Methods

Sixty male Sprague-Dawley rats (300 ± 10 g, 9 weeks old) were divided into three groups: in group I, the anastomosis was sutured in a single layer with 5-0 polypropylene; in group II, the anastomosis was fixed using N-butyl-2-cyanoacrylate (Histoacryl®); and in group III, the anastomosis was sutured and then sealed with N-butyl-2-cyanoacrylate. The rats were sacrificed on postoperative day 7. The anastomoses among the three groups were compared by measuring wound infection, anastomotic leakage, anastomotic stricture, adhesion formation, anastomotic bursting pressure, and histological appearance.

Results

No anastomotic leakage was observed in any group. Anastomotic stricture was significantly more extensive in groups II and III (p < 0.001). Bursting pressure was significantly lower in groups II and III (168 ± 58, 45 ± 21, and 60 ± 38 mmHg for groups I to III, respectively, p < 0.001). The severity of inflammatory reactions was significantly greater and collagen deposition was significantly lower in groups II and III (p < 0.05).

Conclusions

N-butyl-2-cyanoacrylate could be a useful method for sutureless colonic anastomosis based on the absence of anastomotic leakage, but it may impede healing of the colonic anastomosis. In addition, when used to seal sutured colonic anastomoses, cyanoacrylate may have a negative influence on anastomotic healing. The clinical use of N-butyl-2-cyanoacrylate in colonic anastomosis does not appear to be acceptable and safer anastomotic methods or alternative forms of cyanoacrylate should be developed.

Keywords

N-butyl-2-cyanoacrylate Cyanoacrylate Sutureless colonic anastomosis Sealing anastomosis 

Notes

Acknowledgement

This work was supported by National Research Foundation of Korea Grant funded by the Korean Government (2009-0067537)

References

  1. 1.
    Cade D, Gallagher P, Schofield PF, Turner L (1981) Complications of anterior resection of the rectum using EEA stapling device. Br J Surg 68:339CrossRefPubMedGoogle Scholar
  2. 2.
    Chassin JL, Rifkind KM, Sussman B, Kassel B, Finqaret A, Drager S et al (1978) The stapled gastrointestinal tract anastomosis: incidence of postoperative complications compared with the sutured anastomosis. Ann Surg 188:689PubMedCrossRefGoogle Scholar
  3. 3.
    Heberer G, Denecke H, Pratschke E, Teichmann R (1982) Anterior and low anterior resection. World J Surg 6:517CrossRefPubMedGoogle Scholar
  4. 4.
    Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M (1998) Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg 85:355CrossRefPubMedGoogle Scholar
  5. 5.
    Yeh CY, Changchien CR, Wang JY, Chen JS, Chen HH, Chiang JM et al (2005) Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients. Ann Surg 241:9–13PubMedGoogle Scholar
  6. 6.
    Jung SH, Yu CS, Choi PW, Kim DD, Hong DH, Kim HC et al (2006) Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery. J Korean Soc Coloproctol 22:371–379Google Scholar
  7. 7.
    Yoon SJ, Kim JS, Min BS, Kim NK, Baik SH, Lee KY et al (2007) Risk factors for anastomotic leakage after a low anterior resection for rectal cancer. J Korean Soc Coloproctol 23:365–373CrossRefGoogle Scholar
  8. 8.
    Bell SW, Walker KG, Rickard MJFX, Sinclair G, Dent OF, Chapuis PH et al (2003) Anastomotic leakage after curative anterior resection results in a high prevalence of local recurrence. Br J Surg 90:1261–1266CrossRefPubMedGoogle Scholar
  9. 9.
    Matthissen P, Hallböök O, Andersson M, Rutegård J, Sjödahl R (2004) Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis 6:462–469CrossRefGoogle Scholar
  10. 10.
    Branagan G, Finnis D (2005) Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 48(5):1021–1026CrossRefPubMedGoogle Scholar
  11. 11.
    Law WI, Chu KW, Ho JW, Chan CW (2000) Risk Factors for anastomotic leakage after low anterior resection with total mesorectal escision. Am J Surg 179:92–96CrossRefPubMedGoogle Scholar
  12. 12.
    Peeters K, Tollenaar R, Marijnen C, Kranenbarg E, Steup W, Wiggers T et al (2005) Risk factors for anastomotic failure after total mesorectal escision of rectal cancer. Br J Surg 92:211–216CrossRefPubMedGoogle Scholar
  13. 13.
    Tebala GD, Ceriati F, Ceriati E, Vecchioli A, Noris S (1995) The use of cyanoacrylate tissue adhesive in high-risk intestinal anastomoses. Surg Today 25:1069–1072CrossRefPubMedGoogle Scholar
  14. 14.
    Kim TA, Yoon KY, Lee SH, Lee CH (2007) Repair of full-thickness defects in the alimentary tract wall with a bovine pericardium patch and glue. J Korean Surg Soc 73:449–453Google Scholar
  15. 15.
    Van der Hamm AC, Kort WJ, Weijima MI, Van der Ingh HF, Jeekel J (1991) Effect of fibrin sealant on the healing of colonic anastomosis in the rat. Br J Surg 78:49–53CrossRefGoogle Scholar
  16. 16.
    Phillips JD, Kim CS, Fonkalsrud EW, Zeng H, Dindar H (1992) Effects of chronic corticosteroids and vitamin A on the healing of intestinal anastomoses. Am J Surg 163:71–77CrossRefPubMedGoogle Scholar
  17. 17.
    Clark CG, Harris J, Elmasri S, Wyllie JH, Dow J (1972) Polyglycolic acid sutures and catgut in colonic anastomosis: a controlled clinical trial. Lancet 2:1006CrossRefPubMedGoogle Scholar
  18. 18.
    Goligher JC, Graham NG, DeDombal FT (1970) Anastomotic dehiscence after anterior resection of rectum and sigmoid. Br J Surg 57:109CrossRefPubMedGoogle Scholar
  19. 19.
    Irvin TT, Goligher JC (1973) Aetiology of disruption of intestinal anastomoses. Br J Surg 60:461CrossRefPubMedGoogle Scholar
  20. 20.
    Schrock TR, Deveney CW, Dunphy JE (1973) Factors contributing to leakage of colonic anastomoses. Ann Surg 177:513CrossRefPubMedGoogle Scholar
  21. 21.
    Sehapayak S, McNatt M, Carter HG, Bailey W, Baldwin A Jr (1973) Continuous sump-suction drainage of the pelvis after low anterior resection: a reappraisal. Dis Colon Rectum 16:485CrossRefPubMedGoogle Scholar
  22. 22.
    Moran HA (2000) Anastomotic leakage after colorectal anastomosis. Semin Surg Oncol 18:244–248CrossRefPubMedGoogle Scholar
  23. 23.
    McCue JL, Phillips RKS (1991) Sutureless intestinal anastomoses. Br J Surg 78:1291–1296CrossRefPubMedGoogle Scholar
  24. 24.
    Kim SH, Choi HJ, Park KJ, Kim JM, Kim KH, Kim MC et al (2005) Sutureless intestinal anastomosis with the biofragmentable anastomosis ring: experience of 632 anastomoses in a single institute. Dis Colon Rectum 48:2127–2132CrossRefPubMedGoogle Scholar
  25. 25.
    Jansson OK, Zilling TL, Walther BS (1991) Healing of colonic anastomosis: comparative experimental study of glued, manually sutured and stapled anastomoses. Dis Colon Rectum 34:557–562CrossRefPubMedGoogle Scholar
  26. 26.
    Coover HW, Joyner FB, Shearer TH, Wicker TH (1959) Chemistry and performance of cyanoacrylate adhesives. Soc Plastic Engrs J 15:413–417Google Scholar
  27. 27.
    Toriumi DM, Raslan WF, Friedman M, Tardy ME (1990) Histotoxicity of cyanoacrylate tissue adhesives. A comparative study. Arch Otolaryngol Head Neck Surg 116:546–550PubMedGoogle Scholar
  28. 28.
    Cary R. Methyl cyanoacrylate and ethyl cyanoacrylate. Concise International Chemical Assessment Document 36. International program on Chemical Safety and the Inter-Organizational Program for the Sound Management of Chemicals, UNEP/ILO/WHO. Geneva: World Health Organization; 2001. [Cited 7 Oct 2006.] Available from URL: http://www.who.int/ipcs/publications/cicad/cicad36_rev_1.pdf)
  29. 29.
    Seidenberg B, Garrow E, Pimental R, Hurwitt ES (1963) Studies on the use of plastic adhesive in gastro-intestinal surgery. Ann Surg 158:721–725CrossRefPubMedGoogle Scholar
  30. 30.
    Uroskie TW, Swank M, Wolferth CC, Matsumoto T (1971) Effects of isobutyl cyanoacrylate tissue adhesive on small bowel anastomosis in puppies. Am Surg 37:397–399PubMedGoogle Scholar
  31. 31.
    Kanellos I, Mantzoros I, Demetriades H, Kalfadis K, Sakkas L, Kelpis T et al (2002) Sutureless colonic anastomosis in the rat: a randomized controlled study. Tech Coloproctol 6:1436Google Scholar
  32. 32.
    Kirkegaard P, Cristensen AB, Ibsen J, Hegedus V, Christiansen J (1980) Experimental nonsuture colonic anastomoses. Am J Surg 139:233–236CrossRefPubMedGoogle Scholar
  33. 33.
    Ozmen MM, Ozalp N, Zulfikaroglu B, Abbasoglu L, Kacar A, Seckin S, Koc M (2004) Histoacryl blue versus sutured left colonic anastomosis: experimental study. ANZ J Surg 74:1107–1110CrossRefPubMedGoogle Scholar
  34. 34.
    Bhaskar SN (1968) Tissue response of rat tongue to normal and isobutyl cyanoacrylate. Oral Surg Oral Med Oral Pathol 26:5738CrossRefGoogle Scholar
  35. 35.
    Nelsen TS, Anders CJ (1966) Dynamic aspects of small intestinal rupture with special consideration of anastomotic strength. Arch Surg 93:309–314PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Ki-Beom Bae
    • 1
  • Sun-Hee Kim
    • 2
  • Soo-Jin Jung
    • 3
  • Kwan-Hee Hong
    • 1
    Email author
  1. 1.Department of SurgeryInje University College of Medicine, Busan Paik HospitalBusanRepublic of Korea
  2. 2.Paik Institute for Clinical ResearchInje UniversityBusanRepublic of Korea
  3. 3.Department of PathologyInje University College of Medicine, Busan Paik HospitalBusanRepublic of Korea

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