2-Octylcyanoacrylate for the prevention of anastomotic leak

Anthony B. Costales, Deepa Patil, Anny Mulya, John P Kirwan, Chad M. Michener

Research output: Contribution to journalArticle

Abstract

Background: Anastomotic leak after colorectal surgery is a significant cause of morbidity and mortality. The aim of this study was to evaluate the impact of a reinforced colo-colonic anastomosis with tissue adhesive, 2-octylcyanoacrylate (2-OCA), on the integrity of anastomotic healing as measured by anastomotic bursting pressure. Methods: Sixty-eight female Sprague–Dawley rats underwent a rectosigmoid colon transection and a sutured end-to-end anastomosis followed by randomization to receive no further intervention or reinforcement with the tissue adhesive, 2-OCA. After seven postoperative days, a macroscopic assessment of the anastomosis, mechanical assessment to determine anastomotic bursting pressure, and a detailed semi-quantitative histopathologic healing assessment were performed. Results: Thirty-four animals were randomized to each group. Study characteristics did not differ between the groups. There was also no difference in the degree of adhesions present postoperatively. Although there was no difference between the net proximal and distal luminal areas in the two groups (0.37 cm2 versus 0.55 cm2, P = 0.26), the 2-OCA group exhibited evidence of stricture in 15% of anastomoses as compared with 3% in the suture-only group (P < 0.0001). Histologically, the presence of only fibroblasts density was statistically more evident in the 2-OCA group compared with the sutured-only anastomosis (P = 0.0183). There was not a significant increase in mechanical strength in the 2-OCA group (238.9 mm Hg) versus in the suture-only group (231.8 mm Hg). There was no difference in the rate of anastomotic leak in the 2-OCA as compared with the suture-only group (9.1 versus 8.8%). Conclusions: Application of 2-OCA to reinforce a colo-colonic anastomosis clinically provides no benefit to its mechanical strength and detrimentally increases the rate of obstruction and/or stricture in this in vivo model.

LanguageEnglish (US)
Pages166-172
Number of pages7
JournalJournal of Surgical Research
Volume226
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

Fingerprint

Anastomotic Leak
Tissue Adhesives
Sutures
Pathologic Constriction
Pressure
Colorectal Surgery
Random Allocation
octyl 2-cyanoacrylate
Sprague Dawley Rats
Colon
Fibroblasts
Morbidity
Mortality

Keywords

  • 2-Octylcyanoacrylate
  • Adhesive
  • Anastomosis leak
  • Debulking
  • Ovarian cancer

ASJC Scopus subject areas

  • Surgery

Cite this

2-Octylcyanoacrylate for the prevention of anastomotic leak. / Costales, Anthony B.; Patil, Deepa; Mulya, Anny; Kirwan, John P; Michener, Chad M.

In: Journal of Surgical Research, Vol. 226, 01.06.2018, p. 166-172.

Research output: Contribution to journalArticle

Costales, Anthony B. ; Patil, Deepa ; Mulya, Anny ; Kirwan, John P ; Michener, Chad M. / 2-Octylcyanoacrylate for the prevention of anastomotic leak. In: Journal of Surgical Research. 2018 ; Vol. 226. pp. 166-172.
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abstract = "Background: Anastomotic leak after colorectal surgery is a significant cause of morbidity and mortality. The aim of this study was to evaluate the impact of a reinforced colo-colonic anastomosis with tissue adhesive, 2-octylcyanoacrylate (2-OCA), on the integrity of anastomotic healing as measured by anastomotic bursting pressure. Methods: Sixty-eight female Sprague–Dawley rats underwent a rectosigmoid colon transection and a sutured end-to-end anastomosis followed by randomization to receive no further intervention or reinforcement with the tissue adhesive, 2-OCA. After seven postoperative days, a macroscopic assessment of the anastomosis, mechanical assessment to determine anastomotic bursting pressure, and a detailed semi-quantitative histopathologic healing assessment were performed. Results: Thirty-four animals were randomized to each group. Study characteristics did not differ between the groups. There was also no difference in the degree of adhesions present postoperatively. Although there was no difference between the net proximal and distal luminal areas in the two groups (0.37 cm2 versus 0.55 cm2, P = 0.26), the 2-OCA group exhibited evidence of stricture in 15{\%} of anastomoses as compared with 3{\%} in the suture-only group (P < 0.0001). Histologically, the presence of only fibroblasts density was statistically more evident in the 2-OCA group compared with the sutured-only anastomosis (P = 0.0183). There was not a significant increase in mechanical strength in the 2-OCA group (238.9 mm Hg) versus in the suture-only group (231.8 mm Hg). There was no difference in the rate of anastomotic leak in the 2-OCA as compared with the suture-only group (9.1 versus 8.8{\%}). Conclusions: Application of 2-OCA to reinforce a colo-colonic anastomosis clinically provides no benefit to its mechanical strength and detrimentally increases the rate of obstruction and/or stricture in this in vivo model.",
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