Original articleSurgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy
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