External coating of colonic anastomoses: a systematic review.
OBJECTIVE
Colon anastomotic leakage remains both a frequent and serious complication in gastrointestinal surgery. External coating of colonic anastomoses has been proposed as a means to lower the rate of this complication. The aim of this review was to evaluate existing studies on external coating of colonic anastomoses.


METHODS
CINAHL, EMBASE, and PubMed were searched up to September 2011 to identify studies evaluating external coating of colonic anastomoses.


RESULTS
Forty studies have evaluated 20 different coating materials, of which only fibrin sealant, omental pedicle graft, and hyaluronic acid/carboxymethylcellulose have been used in humans. Fibrin sealant has shown positive, however not significant, results. Omental pedicle graft can be used safely, yet without beneficial effects, whereas hyaluronic acid/carboxymethylcellulose should be avoided due to increased complications. The remaining coating materials have solely been evaluated in experimental animals with many contradictory and few positive results.


CONCLUSIONS
External coating of colonic anastomoses has yet failed to show convincing results. Randomized clinical trials and high-quality experimental studies are warranted to determine the role of fibrin sealant, omental pedicle graft, and other coating materials for prevention of colon anastomotic leakage.
Department of Surgical Gastroenterology D, Center for Perioperative Optimization, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, Denmark. HCPommergaard@gmail.com
Hans-Christian
HC
Pommergaard
Michael Patrick
MP
Achiam
Jacob
J
Rosenberg
D000714:Anastomosis, Surgical; D000818:Animals; D002266:Carboxymethylcellulose Sodium / Q000494:pharmacology; D020099:Coated Materials, Biocompatible / Q000494:pharmacology*; D003106:Colon / Q000187:drug effects* / Q000601:surgery*; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology; D006820:Hyaluronic Acid / Q000494:pharmacology
D020099:Coated Materials, Biocompatible; D015718:Fibrin Tissue Adhesive; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium