Elsevier

Surgery for Obesity and Related Diseases

Volume 6, Issue 5, September–October 2010, Pages 498-501
Surgery for Obesity and Related Diseases

Original article
Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy

https://doi.org/10.1016/j.soard.2009.11.016Get rights and content

Abstract

Background

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.

Methods

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.

Results

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).

Conclusion

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.

Section snippets

Methods

A total of 30 freshly explanted porcine stomachs with contiguous proximal small bowel segments were used for the experiment. The tissue explants were harvested and maintained at 4°C until use. All anastomoses were performed within 24 hours of tissue explantation by a single surgeon. Each stomach and intestine specimen was from a single pig, and each specimen was used only once. The anastomoses were performed approximately 6 cm distal to the gastroesophageal junction on the anterior surface of

Results

All anastomoses were performed successfully. No mechanical stapling errors occurred, with all anastomoses appearing intact with appropriate staple closure.

In experiment 1, we studied the burst pressure of 10 control anastomoses and 10 anastomoses reinforced with BioGlue. The mean burst pressure was 27.4 ± 8.4 mm Hg for the control group and increased to 59.1 ± 19.2 mm Hg for the BioGlue group (P <.001, Table 1 and Fig. 3). The mean burst pressure increased 116% in the BioGlue reinforced

Discussion

In our ex vivo porcine model, BioGlue significantly increased the burst pressure of an intact anastomosis and effectively sealed a defective anastomosis. Although our experiment studied the immediate effects of BioGlue, the effect of BioGlue on live tissue over time needs to be determined. Not all anastomotic leaks are evident intraoperatively, and an in vivo model is needed to clarify the effect of BioGlue on clinically significant leaks that present in the early postoperative period.

The

Conclusion

The results of the present pilot study have shown that BioGlue reinforced an intact anastomosis and effectively sealed a defective anastomosis. One area of particular relevance might be in reoperative surgery, in which the risk of anastomotic leaks is significantly greater [24]. More rigorous in vivo and clinical studies are needed to clarify the clinical significance of our results.

Disclosures

The authors have no commercial associations that might be a conflict of interest in relation to this article.

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Supported in part by a grant from CryoLife, Kennesaw, Georgia

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