Advertisement

Journal of Gastrointestinal Surgery

, Volume 23, Issue 2, pp 247–255 | Cite as

Clinical Feasibility of Large Gastrotomy Closure Using a Flexible Tissue Glue Based on N-Butyl-2-Cyanoacrylate: Experimental Study in Pigs

  • Francisco Espin AlvarezEmail author
  • Anna M. Rodríguez Rivero
  • Jordi Navinés López
  • Elena Díaz Celorio
  • Jordi Tarascó Palomares
  • Luís Felipe del Castillo Riestra
  • Iva Borisova
  • Jaime Fernández-Llamazares
  • Pau Turon Dols
  • Joan Francesc Julián Ibáñez
Original Article

Abstract

Background

The use of synthetic adhesives such as cyanoacrylates has been established previously for a wide range of clinical indications. However, more research is necessary to evaluate their use in digestive closures or anastomosis. New chemical formulations developed to achieve more flexibility of synthetic adhesives (i.e., based on n-butyl-2-cyanoacrylate) could be an alternative to achieve this purpose. The aim of this study was to investigate the feasibility of using flexible cyanoacrylate adhesives for large gastric incision closure in an animal model.

Methods

Twelve farm pigs were divided in two groups depending on the type of closure method applied. In all cases, extra-large seven centimeters gastrostomies were performed. Braided absorbable hand-sewn interrupted suture versus n-butyl-2-cyanoacrylate with softener closure were compared during a 3-week follow-up period. Histopathological aspects, hematologic and inflammatory biomarkers, and endoluminal pressure tolerated until leakage were assessed. The time spent on both closing procedures was compared.

Results

No differences between the two groups were found in any of the histopathological and inflammatory variables evaluated. The glued group tolerated a significantly higher pressure than the manual suture group. A reduction of surgery time was also observed.

Conclusions

Our results suggest that flexible cyanoacrylates could be a feasible alternative to improve the clinical outcome of the closure of hollow viscera through more efficient sutureless procedures.

Keywords

Gastrotomy Surgical anastomosis Anastomotic leak Tissue glue Cyanoacrylates Histoacryl General surgery 

Notes

Authors’ Contribution

JF. Julian and J. Fernández-Llamazares participated in the conception, design, surgical procedures in pigs and final critical revision.

P. Turon, AM Rodríguez, LF. del Castillo and E. Díaz participated in the conception, design, execution and final critical revision.

F. Espin and I. Vorisova contributed to analysis, interpretation of data, structure and drafting.

J. Navinés and J. Tarascó participated in the acquisition, analysis and interpretation of data.

Compliance with Ethical Standards

The authors declare that the Investigational Review Board and the Ethical committee of our institution approved the study and that they have no conflict of interest.

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The present work has been developed under agreement between B. Braun Surgical, S.A. and The Catalonian Public Health Institute (ICS), Barcelona, Spain. The authors disclosed that Histoacryl® Flexible was employed for investigational use. Histoacryl® Flexible is not approved for internal use, only for skin closure.

References

  1. 1.
    Sheridan CB, Zyromski N, Mattar S. How to always do a safe anastomosis. Contemp Surg. 2008;64:68–74.Google Scholar
  2. 2.
    Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg. 2009;13:239–245.Google Scholar
  3. 3.
    Sparreboom CL, Wu ZQ, Ji JF, et al. Integrated approach to colorectal anastomotic leakage: Communication, infection and healing disturbances. World J Gastroenterol. 2016;22:7226–7235.Google Scholar
  4. 4.
    Bhatia SK, Yetter AB. Correlation of visual in vitro cytotoxicity ratings of biomaterials with quantitative in vitro cell viability measurements. Cell Biol Toxicol. 2008;24:315–319.Google Scholar
  5. 5.
    Pascual G, Sotomayor S, Rodríguez M, et al. Cytotoxicity of Cyanoacrylate-Based Tissue Adhesives and Short-Term Preclinical In Vivo Biocompatibility in Abdominal Hernia Repair. PLoS One. 2016;11:e0157920.Google Scholar
  6. 6.
    Mizrahi B, Stefanescu CF, Yang C, et al. Elasticity and safety of alkoxyethyl cyanoacrylate tissue adhesives. Acta Biomater. 2011;7:3150–3157.Google Scholar
  7. 7.
    Montanaro L, Arciola CR, Cenni E, et al. Cytotoxicity, blood compatibility and antimicrobial activity of two cyanoacrylate glues for surgical use. Biomaterials. 2001;22:59–66.Google Scholar
  8. 8.
    Pratt GF, Rozen WM, Westwood A, et al. Technology-assisted and sutureless microvascular anastomoses: evidence for current techniques. Microsurgery. 2012;32:68–76.Google Scholar
  9. 9.
    Lumsden AB, Heyman ER. Closure Medical Surgical Sealant Study Group. Prospective randomized study evaluating an absorbable cyanoacrylate for use in vascular reconstructions. J Vasc Surg. 2006;44:1002–1009.Google Scholar
  10. 10.
    Piñeros-Fernández A, Rodeheaver PF, Rodeheaver GT. Octyl 2-cyanoacrylate for repair of peripheral nerve. Ann Plast Surg. 2005;55:188–195.Google Scholar
  11. 11.
    Paral J, Subrt Z, Lochman P, et al. Suture-free anastomosis of the colon. Experimental comparison of two cyanoacrylate adhesives. J Gastrointest Surg. 2011;15:451–459.Google Scholar
  12. 12.
    Bae KB, Kim SH, Jung SJ, et al. Cyanoacrylate for colonic anastomosis; is it safe? Int J Colorectal Dis. 2010;25:601–606.Google Scholar
  13. 13.
    Ozmen MM, Ozlap N, Zulfikagoru B, et al. Hystoacryl blue versus sutured left colonic anastomosis: experimental study. ANZ J Surg. 2004;74:1107–1110.Google Scholar
  14. 14.
    Donkerwolcke M, Burny F, Muster D. Tissues and bone adhesives--historical aspects. Biomaterials. 1998;19:1461–1466.Google Scholar
  15. 15.
    Cho E, Jun CH, Cho SB, et al. Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies? Medicine (Baltimore) 2017;96:e7157.Google Scholar
  16. 16.
    Buechter M, Kahraman A, Manka P, et al. Partial spleen embolization reduces the risk of portal hypertension-induced upper gastro-intestinal bleeding in patients not eligible for TIPS implantation. PLoS One. 2017;12:e0177401.Google Scholar
  17. 17.
    Holster IL, Tjwa ET, Moelker A, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy + β-blocker for prevention of variceal rebleeding. Hepatology. 2016;63:581–589.Google Scholar
  18. 18.
    Kozie S, Kobryñ K, Paluszkiewicz R, et al. Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2 cyanoacrylate. Prz Gastroenterol. 2015;10:239–243.Google Scholar
  19. 19.
    Jang WS, Shin HP, Lee JI, et al. Proton pump inhibitor administration delays rebleeding after endoscopic gastric variceal obturation. World J Gastroenterol. 2014;20:17127–17131.Google Scholar
  20. 20.
    Lo GH, Lin CW, Perng DS, et al. A retrospective comparative study of histoacryl injection and banding ligation in the treatment of acute type 1 gastric variceal hemorrhage. Scand J Gastroenterol. 2013;48:1198–1204.Google Scholar
  21. 21.
    Prachayakul V, Aswakul P, Chantarojanasiri T, et al. Factors influencing clinical out-comes of Histoacryl® glue injection-treated gastric variceal hemorrhage. World J Gastroenterol. 2013;19:2379–2387.Google Scholar
  22. 22.
    Liew W, Wai YY, Kosai NR, et al. Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers. Hernia. 2017;21:549–554.Google Scholar
  23. 23.
    Silveira RK, Domingie S, Kirzin S, et al. Comparative study of safety and efficacy of synthetic surgical glue for mesh fixation in ventral rectopexy. Surg Endosc. 2017;31:4016–4024.Google Scholar
  24. 24.
    Dauser B, Szyszkowitz A, Seitinger G, et al. A novel glue device for fixation of mesh and peritoneal closure during laparoscopic inguinal hernia repair: short- and medium-term results. Eur Surg. 2017;49:27–31.Google Scholar
  25. 25.
    Shen YM, Liu YT, Chen J, et al. Efficacy and safety of NBCA (n-butyl-2-cyanoacrylate) medical adhesive for patch fixation in totally extraperitoneal prosthesis (TEP): a prospective, randomized, controlled trial. Eur Rev Med Pharmacol Sci. 2017;21:680–686.Google Scholar
  26. 26.
    Yontar Y, Özyazgan Ý. Correcting Concavity of Rabbit Auricular Cartilage: Comparison of Single Scoring Incisions with Butyl Cyanoacrylate-Aided Techniques. Plast Reconstr Surg. 2017;139:1152–1164.Google Scholar
  27. 27.
    Dundar S, Ozgur C, Yaman F, et al. Guided bone regeneration with local zoledronic acid and titanium barrier: An experimental study. Exp Ther Med. 2016;12:2015–2020.Google Scholar
  28. 28.
    Salata LA, Mariguela VC, Antunes AA, et al. Short-term evaluation of grafts fixed with either N-butyl-2-cyanocrylate or screws. J Oral Maxillofac Surg. 2014;72:676–682.Google Scholar
  29. 29.
    de Oliveira Neto PJ, Cricchio G, Hawthorne AC, et al. Tomographic, histological, and immunohistochemical evidences on the use of N-butyl-2-cyanoacrilate for onlay graft fixation in rabbits. Clin Implant Dent Relat Res. 2012;14:861–71.Google Scholar
  30. 30.
    Ekelund A, Nilsson OS. Tissue adhesives inhibit experimental new bone formation. Int Orthop. 1991;15:331–334.Google Scholar
  31. 31.
    Wells JR, Gernon WH. Bony ossicular fixation using 2-cyano-butyl-acrylate adhesive. Ach Otolaryngol Head Neck Surg. 1987;113:644–646.Google Scholar
  32. 32.
    Koltai PJ, Eden AR. Evaluation of three cyanoacrylate glues for ossicular reconstruction. Ann Otol Rhinol Laryngol. 1983;92:29–32.Google Scholar
  33. 33.
    Weiss M, Haj M. Gastrointestinal anastomosis with histoacryl glue in rats. J Invest Surg. 2001;14:9–13.Google Scholar
  34. 34.
    Yurtçu M, Arbag H, Cağlayan O, et al. The effect of cyanoacrylate in esophagocutaneous leakages occurring after esophageal anastomosis. Int J Pediatr Otorhinolaryngol. 2009;73:1053–1055.Google Scholar
  35. 35.
    Bianchi Cardona A, Hidalgo Grau LA, Feliu Canaleta J, et al. Postoperative cervical anastomotic fistula treated with a biologic glue. Eur J Surg Oncol. 2005;31:1222–1223.Google Scholar
  36. 36.
    Lukish J, Marmon L, Burns C. Nonoperative closure of persistent gastrocutaneous fistulas in children with 2-octylcyanoacrylate. J Laparoendosc Adv Surg Tech A. 2010;206:565–567.Google Scholar
  37. 37.
    Wu Z, Boersema GS, Vakalopoulos KA, et al. Critical analysis of cyanoacrylate in intestinal and colorectal anastomosis. J Biomed Mater Res B Appl Biomater. 2014;102:635–642.Google Scholar
  38. 38.
    Julián Ibáñez JF, Tarascó Palomares J, Navinés López J, et al. Introduction of Flexible Cyanoacrylates in Sutureless Gastric Closure. Surg Innov. 2016;23:490–497.Google Scholar
  39. 39.
    Festing S, Wilkinson R. The ethics of animal research. Talking Point on the use of animals in scientific research. EMBO Reports. 2007;8(6):526–530.Google Scholar
  40. 40.
    Zühlke HV, Lorenz EM, Straub EM, et al. Pathophysiology and classification of adhesions. Langenbecks Arch Chir Verh Dtsch Ges Chir. 1990:1009–1016.Google Scholar
  41. 41.
    Paral J, Subrt Z, Lochman P, et al. Suture-free anastomosis of the colon. Experimental comparison of two cyanoacrylate adhesives. J Gastrointest Surg. 2011;15:451–459.Google Scholar
  42. 42.
    Nursal TZ, Anarat R, Bircan S, et al. The effect of tissue adhesive, octyl-cyanoacrylate, on the healing of experimental high-risk and normal colonic anastomoses. Am J Surg. 2004;187:28–32.Google Scholar
  43. 43.
    Matsumoto MT, Hardaway RM 3rd, Pani KC, et al. Closure of gastrointestinal perforations with cyanocrylate tissue adhesive. Arch Surg. 1967;94:184–186.Google Scholar
  44. 44.
    Ersoy OF, Ozkan N, Celik A, et al. Effect of cyanocrylate on closure of gastric perforation: a comparative study in a rat model. Minim Invasive Ther Allied Technol. 2009;18:225–231.Google Scholar
  45. 45.
    Howell JM, Bresnahan KA, Stair TO, et al. Comparison of effects of suture and cyanoacrylate tissue adhesive on bacterial counts in contaminated lacerations. Antimicrob Agents Chemother. 1995;39:559–560.Google Scholar
  46. 46.
    Bot GM, Bot KG, Ogunranti JO, et al. The use of cyanoacrylate in surgical anastomosis: an alternative to microsurgery. J Surg Tech Case Rep. 2010;2:44–48.Google Scholar
  47. 47.
    Phillips RJ, Powley TL. Plasticity of vagal afferents at the site of an incision in the wall of the stomach. Auton Neurosci. 2005;123:44–53.Google Scholar
  48. 48.
    Vakalopoulos KA, Wu Z, Kroese LF, et al. Clinical, mechanical, and immunohistopathological effects of tissue adhesives on the colon: An in-vivo study. J Biomed Mater Res B Appl Biomater. 2016;105:846–854.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Francisco Espin Alvarez
    • 1
    Email author
  • Anna M. Rodríguez Rivero
    • 2
  • Jordi Navinés López
    • 1
  • Elena Díaz Celorio
    • 2
  • Jordi Tarascó Palomares
    • 1
  • Luís Felipe del Castillo Riestra
    • 2
  • Iva Borisova
    • 1
  • Jaime Fernández-Llamazares
    • 1
  • Pau Turon Dols
    • 2
  • Joan Francesc Julián Ibáñez
    • 1
  1. 1.Department of Surgery, Germans Trias I Pujol HospitalUniversitat Autònoma de BarcelonaBadalona (Barcelona)Spain
  2. 2.B. Braun SurgicalS.A. Rubí (Barcelona)Spain

Personalised recommendations