©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2016; 8(9): 627-633
Published online Sep 27, 2016. doi: 10.4240/wjgs.v8.i9.627
Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats
Juan Manuel Suárez-Grau, Department of General and Digestive Surgery, Riotinto Hospital, 21660 Huelva, Spain
Juan Manuel Suárez-Grau, Division of General and Laparoscopic Surgery, Clinic Quiron Sagrado Corazón, 41013 Seville, Spain
Juan Manuel Suárez-Grau, Institute of Biomedicine of Seville Research Center, University Hospital Virgen del Rocio, 41013 Seville, Spain
Carlos Bernardos García, Division of General Surgery, Hospital of San Juan de Dios, 41930 Bormujos, Spain
Carmen Cepeda Franco, Fernando Docobo Durantez, Salvador Morales-Conde, Javier Padillo Ruiz, Department of General and Digestive Surgery, University Hospital Virgen del Rocio, 41013 Seville, Spain
Cristina Mendez García, Department of General surgery, Hospital of Jerez, 11407 Jerez de la Frontera, Cadiz, Spain
Salud García Ruiz, Division of Surgery, Clinic Quiron Donostia, 20012 Donostia, Spain
Salvador Morales-Conde, Clinic Quiron Sagrado Corazón, 41013 Seville, Spain
Author contributions: Suárez-Grau JM and Bernardos García C wrote the paper; Suárez-Grau JM, Bernardos García C, Cepeda Franco C, Mendez García C and García Ruiz S performed the experiments and participated equally in treatment of animals; Suárez-Grau JM and Bernardos Garcia C analyzed the data and reviewed the manuscript; Docobo Durantez F, Morales-Conde S and Padillo Ruiz J designed and coordinated the research.
Institutional review board statement: The appropriate approvals were obtained from the relevant Institutional Review Board of General and Digestive Surgery Department of University Hospital of Virgen del Rocío (Seville) and Riotinto Hospital (Huelva), as well as from the research ethics committee of both hospitals.
Institutional animal care and use committee statement: The study was approved by the Ethics Committee for experimental studies and experimental surgery Research Center, Institute of Biomedicine of Seville (IBIS). Animals were cared for at all times by qualified care professionals.
Conflict-of-interest statement: There is no conflict of interest in performing this study by either of the authors; material was donated by the Department of General and Digestive Surgery of Riotinto Hospital and Virgen del Rocío Hospital.
Data sharing statement: An independent statistical employee of the University Hospital of Virgen del Rocío performed the blinded data statistical analysis.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Juan Manuel Suárez-Grau, MD, PhD, Department of General and Digestive Surgery, Riotinto Hospital. Av. la Esquila, 5 Minas de Riotinto, 21660 Huelva, Spain. firstname.lastname@example.org
Telephone: +34-62-9739398 Fax: +34-95-9252250
Received: January 18, 2016
Peer-review started: January 20, 2016
First decision: February 15, 2016
Revised: July 6, 2016
Accepted: July 20, 2016
Article in press: July 22, 2016
Published online: September 27, 2016
To evaluate the effectiveness of human fibrinogen-thrombin collagen patch (TachoSil®) in the reinforcement of high-risk colon anastomoses.
A quasi-experimental study was conducted in Wistar rats (n = 56) that all underwent high-risk anastomoses (anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group (24 rats) and treatment group (24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil® (a piece of TachoSil® was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes.
Overall survival was 71.4% and 57.14% in the TachoSil® group and control group, respectively (P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage (P > 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups (P = 0.066).
In our study, the use of TachoSil® was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil® has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.
Core tip: Anastomotic leakage is one of the most important complications in gastrointestinal surgery. We have performed a pioneering risk anastomosis procedure, carried out with a high risk of leakage, to test the use of thrombin and fibrinogen patch for the reinforcement and prevention of potential leakage. We obtained a significant reduction in the mortality rate without adding comorbidity. Patch application is simple and does not exceed operating time, and its use can be extremely helpful in emergency surgery or special situations that provide a high possibility of anastomosis dehiscence.