Abstract

Tyge Nordentoft, Kathrine Holte

Background: Anastomotic leakage remains a major complication following colorectal surgery, with a largely unknown pathophysiology and limited treatment options. Previous clinical studies have revealed that many leakages on colo-rectal anastomoses remain subclinical. Prior attempts at prophylactic mechanical sealing of gastrointestinal anastomoses, i.e., the application of various forms of mesh and fibrin components, have been disappointing. We therefore decided to determine whether a collagen patch coated with fibrin glue components (TachoSil®) is able to seal leaking colonic anastomoses and thereby prevent clinical leakage and peritonitis. Material and methods: Prospective study on 20 pigs operated with experimentally induced defects in colonic anastomoses randomized to sealing vs. no sealing with a collagen patch coated with fibrin glue components. The primary study endpoints were visible leakage at the anastomotic site, death or illness causing sacrifice and fecal peritonitis (local or diffuse). Results: A significant reduction in macroscopic anastomotic leakage in the group of pigs with sealed anastomoses was found (2/10 vs. 9/10, p=0.0055). Furthermore, macroscopic examination of the abdominal cavity (n=20) showed a significant decrease in peritonitis in the sealed vs. non-sealed groups (2 vs. 9, p=0.0055). Additionally, a reduction, although non-significant, in dead and sacrificed animals before the end of the observation period (1 vs. 4) was found in the sealed group. Conclusion: A collagen patch coated with fibrin glue components efficiently seals leaking gastrointestinal anastomoses in pigs. Whether these results may be applied to humans in order to prevent clinical anastomotic dehiscence must be investigated in future randomized clinical studies