Comparison of healing after cystotomy and repair with fibrin glue and sutured closure in the porcine model.
OBJECTIVE
We compared healing after laparoscopic cystotomy using fibrin glue, sutures, or a combination to determine whether fibrin glue can obviate the need for sutures and whether there is any detriment when glue is used in the presence of sutures.


METHODS
In 24 Yorkshire pigs, a 3.5 cm vertical cystotomy was created laparoscopically and repaired as follows: Group 1--no closure; group 2--fibrin glue closure; group 3--suture repair; group 4--combined fibrin glue and suture repair. All animals had a Foley catheter for 1 week. In each group, three animals were harvested at 1 week (acute) and three animals were harvested at 6 weeks (chronic).


RESULTS
Acute: Group 1--all pigs had an unhealed defect that leaked when evaluated by cystography. Groups 2, 3, 4--mean leak pressures were 80, 97, and 60 cm H(2)O (P = 0.36), respectively. Mean bladder capacity was not significantly different between groups. Chronic: No leakage seen on a cystogram at 1 week; at 6 weeks, bladders were filled at > or =95 to 100 cm H(2)O without leakage. Histologically, there was more inflammation in the acute group v chronic group pigs. In the acute group pigs repaired with glue or suture + glue, there was more inflammation and less epithelial continuity than in the suture alone group. At 6 weeks, there was no difference between groups.


CONCLUSIONS
Fibrin glue provoked an intense inflammatory response that might have delayed healing acutely, resulting in a lower burst pressure in both scenarios in which it was used (i.e., alone or in combination with sutures). However, by 6 weeks, there did not seem to be any difference between groups either clinically or histopathologically.
Borin
James F
JF
Department of Urology, University of California-Irvine, 101 The City Drive, Orange, CA 92612, USA. jborin@uci.edu
Deane
Leslie A
LA
Sala
Leandro G
LG
Abdelshehid
Corollos S
CS
White
Shannon M
SM
Poulson
Alfred Krebs
AK
Khan
Farhan
F
Edwards
Robert A
RA
McDougall
Elspeth M
EM
Clayman
Ralph V
RV
D000818:Animals; D053715:Cystotomy; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D034421:Sus scrofa; D013537:Sutures; D014014:Tissue Adhesives / Q000627:therapeutic use*; D001743:Urinary Bladder / Q000601:surgery; D014945:Wound Healing
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives