title: Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy.
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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Weill Cornell Medical College, New York, New York 1006, USA.
authors.forename: Govind
authors.initials: G
authors.lastname: Nandakumar
authors.forename: Bryson G
authors.initials: BG
authors.lastname: Richards
authors.forename: Koiana
authors.initials: K
authors.lastname: Trencheva
authors.forename: Gregory
authors.initials: G
authors.lastname: Dakin
mesh_terms: D057868:Anastomotic Leak / Q000517:prevention & control*; D000818:Animals; D015390:Gastric Bypass / Q000379:methods*; D011312:Pressure; D011506:Proteins; D017792:Surgical Stapling; D013552:Swine
chemical_list: C472676:Bio-glue; D011506:Proteins