title: Tissue sealants in endoscopic applications for anastomotic leakage during a 25-year period.
abstract: BACKGROUND
  Anastomotic leakage after gastrointestinal operation is a complication difficult to manage because conservative therapy and/or reoperation may be unsuccessful and carry the risk of increased morbidity and mortality. The endoscopic use of tissue sealants appears to be a promising alternative to avoid operation.
  
  
  METHODS
  We present conclusively our 25-year experience with tissue sealing in a series of 63 patients referred after gastrointestinal anastomosis leakage; 48 of the upper and 15 of the lower gastrointestinal tract, experiencing a drainage volume ranging 50-2,400 mL.
  
  
  RESULTS
  Tissue glue was applied orally in 37, anally in 10, through the fistula tract in 8, and through a combination of approximation routes in another 8 cases. Biological glue (fibrin) was used in 47, cyanoacrylate in 8, and both glue types in another 8 patients. The total volume of fibrin applied was 2-36 mL, in a median of four sessions, 0.5-4 mL for cyanoacrylate, in a median of two sessions, and, whenever a combination of glues was used, a volume of 12-40 mL of fibrin plus 1-4 mL of cyanoacrylate, in a median of nine sessions. The median hospital stay after initiation of gluing was 14 days (range 8-32). The clinical and technical success rate was 96.8% (61 of 63 patients).
  
  
  CONCLUSIONS
  Tissue glue appears to be a valuable clinical tool that would prevent further operative interventions and the associated morbidity and mortality after a gastrointestinal anastomosis dehiscence. However, it must be borne in mind that repeated sessions and large volumes of sealants are necessary in many cases.
authors.affiliation: Department of Surgery, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Katerina
authors.initials: K
authors.lastname: Kotzampassi
authors.affiliation: Department of Surgery, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece. Electronic address: ele.makis@yahoo.com.
authors.forename: Efthymios
authors.initials: E
authors.lastname: Eleftheriadis
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000628:therapy*; D003487:Cyanoacrylates / Q000008:administration & dosage*; D016145:Endoscopy, Digestive System; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D014014:Tissue Adhesives / Q000008:administration & dosage*
chemical_list: D003487:Cyanoacrylates; D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives