title: Fibrin glue injection method with diluted thrombin for refractory postoperative digestive fistula.
abstract: BACKGROUND
  The injection of the biological adhesive fibrin glue is often performed to treat postoperative digestive fistulas. However, it is not always effective especially in case of complex fistulas with large cavities, because the fibrin glue will coagulate before the mixed solutions fill the cavity, creating dead space. We report the results of fibrin glue injection with diluted thrombin solution.
  
  
  METHODS
  We studied the tensile strength and coagulation time of the resulting fibrin glue at each dilution of the thrombin solution. Based on in vitro study, 18 patients who had developed postoperative digestive fistula were treated by fibrin glue injection with diluted thrombin solution.
  
  
  RESULTS
  In vitro study proved that the dilution of thrombin prolonged the coagulation time of the fibrin glue to more than 1 minute with almost no change to the tensile strength of the glue until a certain dilution was reached. The fistulas of 16 patients were successfully closed.
  
  
  CONCLUSIONS
  Our simple method of fibrin glue injection is useful for refractory postoperative digestive fistula, even in cases of complex fistula with large cavities.
authors.affiliation: Department of Surgery, NTT, West Osaka Hospital, Osaka, Japan. mmurakami@surg2.med.osaka-u.ac.jp
authors.forename: Masahiro
authors.initials: M
authors.lastname: Murakami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tono
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Okada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yano
authors.forename: Takushi
authors.initials: T
authors.lastname: Monden
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016154:Digestive System Fistula / Q000188:drug therapy*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D013718:Tensile Strength; D013917:Thrombin / Q000008:administration & dosage*; D014014:Tissue Adhesives / Q000008:administration & dosage*
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives; D013917:Thrombin