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Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To evaluate the effectiveness of human fibrinogen-thrombin collagen patch (TachoSil®) in the reinforcement of high-risk colon anastomoses.

Methods: 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.

Results: 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).

Conclusion: 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.

No MeSH data available.


Surgical technique.
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Figure 1: Surgical technique.

Mentions: Anesthesia was induced with intraperitoneal ketamine (20 mg/kg), after which a laparotomy was performed. We then performed a partial colectomy of 2-3 cm just after the cecum, which was closed with an anastomosis with only two stitches of 4-0 monocryl in the mesenteric and anti-mesenteric borders of the colon. In addition, a 2 cm × 2 cm piece of TachoSil® was applied over the anastomosis, with light compression using small, wet gauze in the treatment group. Each piece was lightly wetted with 0.9% saline. The gauze was gently removed and the anastomosis site checked after 5 min to ensure the TachoSil® was in the proper location. The laparotomy was closed with 3-0 vicryl suture in a simple continuous suture for the muscle plane and 3-0 silk in a simple interrupted suture for the skin (Figure 1).


Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats
Surgical technique.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037336&req=5

Figure 1: Surgical technique.
Mentions: Anesthesia was induced with intraperitoneal ketamine (20 mg/kg), after which a laparotomy was performed. We then performed a partial colectomy of 2-3 cm just after the cecum, which was closed with an anastomosis with only two stitches of 4-0 monocryl in the mesenteric and anti-mesenteric borders of the colon. In addition, a 2 cm × 2 cm piece of TachoSil® was applied over the anastomosis, with light compression using small, wet gauze in the treatment group. Each piece was lightly wetted with 0.9% saline. The gauze was gently removed and the anastomosis site checked after 5 min to ensure the TachoSil® was in the proper location. The laparotomy was closed with 3-0 vicryl suture in a simple continuous suture for the muscle plane and 3-0 silk in a simple interrupted suture for the skin (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Aim: To evaluate the effectiveness of human fibrinogen-thrombin collagen patch (TachoSil®) in the reinforcement of high-risk colon anastomoses.

Methods: 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.

Results: 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).

Conclusion: 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.

No MeSH data available.