Antifibrinolytic additives to fibrin glue for laparoscopic wound closure in urinary tract.
OBJECTIVE
Fibrinolytic activity of urine may rapidly degrade fibrin glue used in the urinary tract, thereby limiting tissue adhesion. The goals of this study were to verify the ability of antifibrinolytic agents to delay the degradation of fibrin glue in the urinary tract and to assess the results of this delay on subsequent wound healing.


METHODS
In 25 domestic pigs, a 3.5-cm incision in the urinary bladder was left open (N = 6) or closed laparoscopically with fibrin glue alone (N = 6), fibrin glue containing aprotinin 5000 KIU/mL (N = 6), or fibrin glue containing aprotinin 2500 KIU/mL with (N = 4) or without (N = 3) aminocaproic acid 12.5 mg/mL. At harvest 7 days later, the bladder was tested for leakage. Histologic features were scored by a pathologist blinded to the closure method.


RESULTS
There were no significant differences among the groups in the amount of leakage at harvest. Significant fibrin glue material in the wound was noted more often in the pigs treated with fibrin glue plus aprotinin (7 of 13) than in the fibrin glue-only group (0 of 6; P = 0.04). The presence of significant fibrin material in the wound correlated well with absence of granulation tissue (P < 0.001), such that granulation tissue bridging the wound edges was found more often in the fibrin glue-only group (6 of 6) than in the groups treated with fibrin glue plus aprotinin (4 of 13; P = 0.01).


CONCLUSIONS
Although aprotinin +/- aminocaproic acid did delay the degradation of fibrin glue used to close a bladder wound, it was associated with inhibition of granulation tissue in the glued wound. These findings suggest that aprotinin alone and aprotinin plus aminocaproic acid are not useful additives to fibrin glue used for wound closure in the urinary tract.
Department of Surgery, University of Michigan, Ann Arbor, USA.
R
R
Beduschi
M C
MC
Beduschi
K J
KJ
Wojno
M
M
Jhung
A L
AL
Williams
J S
JS
Wolf
D000614:Aminocaproates / Q000494:pharmacology; D000818:Animals; D000933:Antifibrinolytic Agents / Q000494:pharmacology*; D007611:Aprotinin / Q000494:pharmacology; D001673:Biodegradation, Environmental / Q000187:drug effects; D004338:Drug Combinations; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D005500:Follow-Up Studies; D010535:Laparoscopy; D013529:Surgical Wound Dehiscence / Q000517:prevention & control*; D013552:Swine; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000166:cytology / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods*; D014945:Wound Healing / Q000187:drug effects
D000614:Aminocaproates; D000933:Antifibrinolytic Agents; D004338:Drug Combinations; D015718:Fibrin Tissue Adhesive; D007611:Aprotinin