Bowel perforation is a rare, but serious complication of laparoscopic surgery with a mortality rate that reaches 20%. There are several risk factors that could predispose to bowel perforation, but the surgeon's experience and the difficulty of each case play the most important role. Delayed bowel injuries happen due to conduction of electrical energy through the abdominal cavity, and in the majority of cases require reoperation. Early bowel injuries are caused by thermal injury of an electrosurgical instrument or during the insertion of the laparoscopic instruments inside the peritoneal cavity. Such injuries are recognized during the operation and are usually fixed by placing sutures. TISSEEL™ is a fibrin sealant with various applications in several surgical specialties, that simulates the latter stages of the coagulation cascade, and could be used as an alternative treatment for confined bowel perforations during laparoscopy. The efficacy of fibrin sealants in closing bowel gaps has been tested in some experimental models as well as its adequacy in enhancing bowel anastomoses performed with sutures. In addition, there is scarce evidence that fibrin sealants enhance the healing process after bowel enclosure either combined to suturing or not, which is supported by an experimental pilot study, that was conducted by our study group. The present study tries to combine all the available data in order to propose an effective alternative treatment for confined bowel injuries or controversial cases, that happen during laparoscopic surgery. In that way, every surgeon could face them even without huge expertise, conversions to open surgery would diminish and the disadvantages of suturing would disappear. Future experimental studies should be designed in the terms of extensive comparison of the two methods, with the purpose of this comparison to be tested in humans in the future.
Keywords: Bowel; Experimental; Fibrin; Perforation; Sealant.
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