title: Reducing anastomotic leakage by reinforcement of colorectal anastomosis with cyanoacrylate glue.
abstract: BACKGROUND
  Technical failure of sutured or stapled anastomoses may lead to anastomotic leakage, which is one of the most important complications after colorectal surgery. Cyanoacrylate glue (CA) provides strong mechanical attachment, making it a good candidate for suture reinforcement. This study aimed to demonstrate that CA is the most important factor in the strength of a sealed colorectal anastomosis, in both normal and insufficient anastomoses.
  
  
  METHODS
  Ex vivo porcine colorectal segments were resected. A 1-layer continuous anastomosis or an insufficient 6-interrupted-suture anastomosis was created, and the baseline anastomotic bursting pressure (ABP) was measured. The primary anastomosis was then reinforced either by CA or with 4 additional interrupted sutures, further inverting the anastomosis. After reinforcement a second ABP test was performed.
  
  
  RESULTS
  Thirty-two segments were used. Reinforcing the anastomosis by CA significantly increased ABP in both normal and insufficient anastomoses when compared to the primary anastomosis (p < 0.05 for all groups); no significant difference in ABP was found between normal and insufficient anastomosis groups after CA reinforcement. Anastomotic reinforcement with CA was not inferior to the reinforcement with sutures in both normal and insufficient anastomoses, and had significantly fewer ABP variances in normal anastomosis groups (p = 0.042).
  
  
  CONCLUSIONS
  Reinforcing a colorectal anastomosis with CA increases its mechanical strength in both normal and technically insufficient situations, which may contribute to the reduction of anastomotic leakage. CA is promising for anastomotic reinforcement based on mechanical improvement of the anastomosis, and in vivo studies are needed to evaluate its biological effects.
authors.affiliation: Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands. z.wu.1@erasmusmc.nl
authors.forename: Z
authors.initials: Z
authors.lastname: Wu
authors.forename: K A
authors.initials: KA
authors.lastname: Vakalopoulos
authors.forename: L F
authors.initials: LF
authors.lastname: Kroese
authors.forename: G S A
authors.initials: GS
authors.lastname: Boersema
authors.forename: G J
authors.initials: GJ
authors.lastname: Kleinrensink
authors.forename: J
authors.initials: J
authors.lastname: Jeekel
authors.forename: J F
authors.initials: JF
authors.lastname: Lange
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000503:physiopathology / Q000517:prevention & control*; D000818:Animals; D003106:Colon / Q000502:physiology / Q000601:surgery*; D003487:Cyanoacrylates / Q000627:therapeutic use*; D008297:Male; D023421:Models, Animal; D011312:Pressure; D012007:Rectum / Q000502:physiology / Q000601:surgery*; D013314:Stress, Mechanical; D034421:Sus scrofa; D013537:Sutures; D014014:Tissue Adhesives / Q000627:therapeutic use*
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate