Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
J Surg Res. 2013 Oct;184(2):819-24. doi: 10.1016/j.jss.2013.04.015. Epub 2013 Apr 28.
In colorectal surgery, anastomotic leakage (AL) is the most significant complication. Sealants applied around the colon anastomosis may help prevent AL by giving the anastomosis time to heal by mechanically supporting the anastomosis and preventing bacteria leaking into the peritoneal cavity. The aim of this study is to compare commercially available sealants on their efficacy of preventing leakage in a validated mouse model for AL.
Six sealants (Evicel, Omnex, VascuSeal, PleuraSeal, BioGlue, and Colle Chirurgicale Cardial) were applied around an anastomosis constructed with five interrupted sutures in mice, and compared with a control group without sealant. Outcome measures were AL, anastomotic bursting pressure, and death.
In the control group there was a 40% death rate with a 50% rate of AL. None of the sealants were able to diminish the rate of AL. Furthermore, use of the majority of sealants resulted in failure to thrive, increased rates of ileus, and higher mortality rates.
If sealing of a colorectal anastomosis could achieve a reduction of incidence of clinical AL, this would be a promising tool for prevention of leakage in colorectal surgery. In this study, we found no evidence that sealants reduce leakage rates in a mouse model for AL. However, the negative results of this study make us emphasize the need of systemic research, investigating histologic tissue reaction of the bowel to different sealants, the capacity of sealants to form a watertight barrier, their time of degradation, and finally their results in large animal models for AL.
在结直肠手术中，吻合口漏（AL）是最严重的并发症。在结肠吻合口周围应用密封剂可以通过机械地支撑吻合口并防止细菌漏入腹腔来帮助防止 AL，从而使吻合口有时间愈合。本研究的目的是比较市售密封剂在验证的 AL 小鼠模型中预防渗漏的效果。
在小鼠中用五个间断缝线构建吻合口，并在吻合口周围应用六种密封剂（Evicel、Omnex、VascuSeal、PleuraSeal、BioGlue 和 Colle Chirurgicale Cardial），与未用密封剂的对照组进行比较。观察指标为 AL、吻合口爆裂压和死亡。
对照组有 40%的死亡率，AL 发生率为 50%。没有一种密封剂能够降低 AL 的发生率。此外，大多数密封剂的使用导致生长不良、肠梗阻发生率增加和死亡率升高。
如果密封结直肠吻合口可以降低临床 AL 的发生率，这将是预防结直肠手术渗漏的有前途的工具。在本研究中，我们没有发现证据表明密封剂可以降低 AL 小鼠模型中的渗漏率。然而，本研究的阴性结果使我们强调需要进行系统研究，研究不同密封剂对肠道的组织学反应、密封剂形成水密屏障的能力、其降解时间以及最终在 AL 的大动物模型中的结果。
