title: Tissue adhesives in gastrointestinal anastomosis: a systematic review.
abstract: BACKGROUND
  Anastomotic leakage in gastrointestinal (GI) surgery remains a major problem. Although numerous studies have been undertaken on the role of tissue adhesives as GI anastomotic sealants, no clear overview has been presented. This systematic review aims to provide a clear overview of recent experimental and clinical research on the sealing of different levels of GI anastomosis with tissue adhesives.
  
  
  METHODS
  We searched MEDLINE and Embase databases for clinical and experimental articles published after 2000. We included articles only if these addressed a tissue adhesive applied around a GI anastomosis to prevent anastomotic leakage or decrease leakage-related complications. We categorized results according to level of anastomosis, category of tissue adhesive, and level of evidence.
  
  
  RESULTS
  We included 48 studies: three on esophageal anastomosis, 13 on gastric anastomosis, four on pancreatic anastomosis, eight on small intestinal anastomosis, and 20 on colorectal anastomosis; 15 of the studies were on humans.
  
  
  CONCLUSIONS
  Research on ileal and gastric/bariatric anastomosis reveals promising results for fibrin glue sealing for specific clinical indications. Sealing of pancreatico-enteric anastomosis does not seem to be useful for high-risk patients; however, research in this field is limited. Ileal anastomotic sealing was promising in every included study, and calls for clinical evaluation. For colorectal anastomoses, sealing with fibrin glue sealing seems to have more positive results than with cyanoacrylate. Further research should concentrate on the clinical evaluation of promising experimental results as well as on new types of tissue adhesives. This research field would benefit from a systematic experimental approach with comparable methodology.
authors: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. k.a.vakalopoulos@gmail.com
authors: Konstantinos A
authors: KA
authors: Vakalopoulos
authors: Freek
authors: F
authors: Daams
authors: Zhouqiao
authors: Z
authors: Wu
authors: Lucas
authors: L
authors: Timmermans
authors: Johannes J
authors: JJ
authors: Jeekel
authors: Gert-Jan
authors: GJ
authors: Kleinrensink
authors: Arie
authors: A
authors: van der Ham
authors: Johan F
authors: JF
authors: Lange
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D050110:Bariatric Surgery; D003106:Colon / Q000601:surgery; D004947:Esophagus / Q000601:surgery*; D015718:Fibrin Tissue Adhesive; D041981:Gastrointestinal Tract / Q000601:surgery*; D006801:Humans; D007421:Intestine, Small / Q000601:surgery; D010179:Pancreas / Q000601:surgery*; D014014:Tissue Adhesives
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives