2-Octylcyanoacrylate for the prevention of anastomotic leak

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

doi:10.1016/j.jss.2018.01.026

2-Octylcyanoacrylate for the prevention of anastomotic leak

J Surg Res. 2018 Jun:226:166-172. doi: 10.1016/j.jss.2018.01.026. Epub 2018 Feb 22.

Authors

Anthony B Costales¹, Deepa Patil², Anny Mulya³, John P Kirwan⁴, Chad M Michener⁵

Affiliations

¹ Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio. Electronic address: costala@ccf.org.
² Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
³ Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
⁴ Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio; Metabolic Translational Research Center, Endocrine and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
⁵ Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic Foundation, Cleveland, Ohio.

PMID: 29661283
DOI: 10.1016/j.jss.2018.01.026

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 cm²versus 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.

Keywords: 2-Octylcyanoacrylate; Adhesive; Anastomosis leak; Debulking; Ovarian cancer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anastomosis, Surgical / adverse effects
Anastomotic Leak / epidemiology
Anastomotic Leak / etiology
Anastomotic Leak / prevention & control*
Animals
Colon / pathology
Colon / surgery*
Colonic Diseases / epidemiology
Colonic Diseases / etiology
Constriction, Pathologic
Cyanoacrylates / administration & dosage
Cyanoacrylates / adverse effects*
Disease Models, Animal
Female
Humans
Intestinal Obstruction / epidemiology
Intestinal Obstruction / etiology
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Random Allocation
Rats
Rats, Sprague-Dawley
Sutures
Tissue Adhesions
Tissue Adhesives / administration & dosage
Tissue Adhesives / adverse effects*
Treatment Outcome
Wound Healing

Substances

Cyanoacrylates
Tissue Adhesives
octyl 2-cyanoacrylate