Department of Surgery, Weill Cornell Medical College, New York, New York 1006, USA.
Surg Obes Relat Dis. 2010 Sep-Oct;6(5):498-501. doi: 10.1016/j.soard.2009.11.016. Epub 2010 Jan 1.
Leakage from a gastrointestinal anastomosis in bariatric surgery is a catastrophic complication and is the second-most preventable cause of death after Roux-en-Y gastric bypass. Several adjuncts for staple line reinforcement have been investigated to reduce the incidence of this complication. The purpose of our study was to determine whether a commercially available tissue sealant (BioGlue) could reinforce a stapled gastrojejunal anastomosis and whether it could seal an artificially created anastomotic leak.
Circular-stapled gastrojejunostomies were performed on freshly explanted porcine stomach and intestine. Experiment 1 consisted of 10 control nonreinforced gastrojejunostomies and 10 gastrojejunostomies reinforced with BioGlue. The staple lines were submerged in saline and exposed to increased pressure using constant-rate infusion of air. The burst pressures were recorded at the point of visible leakage from the anastomosis. In experiment 2, a small defect was created in 10 gastrojejunostomies. The burst pressures were recorded before and after application of BioGlue to the anastomosis. The data were analyzed using the 2-tailed paired t test.
In experiment 1, the burst pressure was significantly increased in the reinforced gastrojejunostomies, from 27.4 ± 8.4 mm Hg to 59.1 ± 19.2 mm Hg (P <.001). In experiment 2, the defective gastrojejunostomies had an average burst pressure of 1.2 ± 0.8 mm Hg. After application of BioGlue, the burst pressure increased to 42.8 ± 15.9 mm Hg (P <.001).
These ex vivo findings suggest that the surgical adhesive BioGlue can reinforce both intact and defective stapled gastrojejunal anastomoses. Additional in vivo study is warranted to determine whether BioGlue can prevent or help seal gastrojejunal leaks.
减重手术中胃肠道吻合口漏是一种灾难性的并发症，是 Roux-en-Y 胃旁路术后第二大可预防的死亡原因。已经研究了几种附加物来加强吻合线加固，以降低这种并发症的发生率。我们的研究目的是确定一种市售的组织粘合剂（BioGlue）是否可以加强吻合的胃空肠吻合，并是否可以密封人工创建的吻合口漏。
在新鲜取出的猪胃和肠上进行圆形吻合的胃空肠吻合术。实验 1 包括 10 个对照非加固胃空肠吻合术和 10 个用 BioGlue 加固的胃空肠吻合术。吻合线浸泡在盐水中，并通过空气恒速输注增加压力。在吻合口可见泄漏时记录爆裂压力。在实验 2 中，在 10 个胃空肠吻合术中创建一个小缺陷。在应用 BioGlue 于吻合之前和之后记录爆裂压力。使用双尾配对 t 检验分析数据。
在实验 1 中，加固的胃空肠吻合术的爆裂压力显着增加，从 27.4 ± 8.4mmHg 增加到 59.1 ± 19.2mmHg（P <.001）。在实验 2 中，有缺陷的胃空肠吻合术的平均爆裂压力为 1.2 ± 0.8mmHg。应用 BioGlue 后，爆裂压力增加至 42.8 ± 15.9mmHg（P <.001）。
这些离体发现表明手术粘合剂 BioGlue 可以加固完整和有缺陷的吻合的胃空肠吻合。需要进一步的体内研究来确定 BioGlue 是否可以预防或帮助密封胃空肠漏。
