Experimental and clinical use of adhesive on parenchymatous organs

Prevention of pancreatic fistula with a new synthetic, absorbable sealant: evaluation in a dog model

BACKGROUND

Pancreatic fistula complicates up to 15% to 25% of pancreatic resections, especially with soft, normal pancreas, and is most common after distal pancreatectomy. A new synthetic, absorbable hydrogel sealant has recently been developed and tested for sealing of human aorta, bronchi, and dura; it is FDA approved as a lung sealant in humans. Our objective was to test the efficacy of the sealant in preventing pancreatic leaks in a dog model of distal pancreatectomy.

STUDY DESIGN

Ten dogs underwent bilateral distal pancreatectomy under general anesthesia. Animals were randomized to receive application of the sealant to the pancreatic stumps (n = 5) or no treatment (n = 5). The transected pancreatic duct was not ligated, and the end of the pancreas was neither oversewn nor stapled; closed-suction drains were placed in proximity to the pancreatic stumps before abdominal closure. All animals received normal chow starting on the second postoperative day. Drainage was collected for volume and amylase determination twice daily for 14 days, after which the animals were sacrificed. Pancreatic tissue was collected from the area of transection and was formalin fixed for histopathology.

RESULTS

There was no perioperative mortality. Fluid recovered from closed-suction drains in all animals was uniformly amylase-rich. Over the 14-day study period, daily volume of pancreatic drainage was significantly different between control animals and animals treated with sealant (p < 0.001). By postoperative day 6, the total mean pancreatic drainage in dogs treated with sealant was 25 +/- 5 mL/drain (versus 91 +/- 26 mL/drain in untreated dogs; p < 0.05). This is the point at which we remove the drains in our clinical practice. Examination at 14 days revealed intact sealant at the pancreatic stumps in the treatment group, and histopathology showed a characteristic benign histiocyte reaction to the sealant but no other qualitative differences in the degree of inflammation between control and treatment animals. There were no undrained collections or abscesses.

CONCLUSIONS

A new synthetic hydrogel sealant prevents the formation of significant pancreatic fistulae after distal pancreatectomy in the dog and may be suitable for clinical application.

Enteroplication in cats, using suture of N-butyl cyanoacrylate adhesive

Enteroplication has been recommended to prevent recurrence of intussusception in dogs and cats. This study investigated the impact of enteroplication on subsequent function of the plicated small intestine as measured by transit time of barium impregnated polyethylene spheres (BIPS) and compared two methods of achieving enteroplication--sutures using polydioxanone and cyanoacrylate tissue adhesive. Twenty-two healthy young cats were used--four controls, nine sutured and nine glued. The mean +/-SD transit times before, one week after and four weeks after enteroplication were respectively 2.0+/-0.80 hours, 1.6+/-0.80 hours, 2.2+/-1.18 hours. There was no significant difference in transit time or in the time to create enteroplication in the two plicated groups. Maintenance of intestinal adhesion was greater for the sutured plications. There was no significant change in internal diameter with either technique. Adverse clinical signs after enteroplication were not severe, however, they were more prevalent in cats which had glued plication. The inflammation associated with the suture was of a greater depth initially but that associated with the adhesive was more widespread and persisted for the four weeks of the experiments. Enteroplication in cats was a relatively benign procedure which did not cause significant alterations in small intestinal function. However, cyanoacrylate tissue adhesive cannot be recommended for this clinical procedure.

A prospective randomized study of wound approximation with tissue glue in circumcision in children

OBJECTIVE

Bleeding and wound infection are the most common complications of circumcision. Cyanoacrylate tissue glue has been claimed to have the advantage of being haemostatic, bacteriostatic and easy to use. The purpose of this study is to assess the feasibility of using the tissue glue in approximation of circumcision wound in children.

METHODOLOGY

A prospective randomized trial was carried out on 86 boys consecutively admitted into the Duchess of Kent Children's Hospital, Hong Kong. The results of wound approximation with cyanoacrylate tissue glue and suturing with interrupted 4/0 plain catgut were compared. The operations were carried out by the same surgeon using identical technique except for the wound approximation. The wound was assessed 1 day, 2 days, 3 days, 1 week and 1 month postoperatively.

RESULTS

There was no statistically significant difference between the two groups in the rates of wound inflammation, infection, bleeding, dehiscence and cosmetic appearance, but the duration of operation was longer using tissue glue (19.8 min vs 16.5 min, P = 0.002).

CONCLUSIONS

We conclude that tissue glue approximation of circumcision wounds in children is a feasible alternative, but it offers no extra advantage when compared to suturing.

Assessment and management of the hemorrhaging patient

Trauma patients presenting to the veterinarian on an emergency basis commonly have bleeding injuries. Although mild hemorrhage is often self-limiting, severe hemorrhage may be lethal if not surgically controlled. Management of these patients requires rapid assessment and diagnostics so that appropriate treatment is provided in a timely manner. This article describes care of the hemorrhaging patient including assessment, immediate resuscitation, and principles of controlling the hemorrhage. External and surgical methods of treating hemorrhage are discussed, with a concentration on the surgical management of the hemorrhaging patient.

Tobramycin-adhesive in preventing and treating PTFE vascular graft infections

The present study was designed to determine the effectiveness of N-butyl-2-cyanoacrylate as a vehicle to deliver antibiotics locally to contaminated vascular graft sites and to grafts with established infections. Phase I--Contaminated wound model: Sixteen dogs had a 1-cm section of infrarenal aorta replaced with a PTFE graft. Prior to placement, the graft was immersed in solutions of Escherichia coli 3 X 10(8) CFU/ml and then Staphylococcus aureus 3 X 10(8) CFU/ml. After anastomosis, 1 cc of each solution was placed directly over the graft. Eleven dogs served as controls and 5 as treatment dogs. Parenteral cefonecid was given preoperatively and daily until sacrifice. Treatment animals had the anastomoses and graft sealed with a suspension of N-butyl-2-cyanoacrylate and 1.2 g tobramycin powder (antibiotic glue, ANGL) after contamination. All dogs were reoperated on the third postoperative day.

RESULTS

Eleven of 11 control dogs had positive cultures for S. aureus and 9 of 11 had positive cultures for E. coli. Seven of 11 had pseudoaneurysms, 1 exsanguinated. None of the 4 treatment dogs had positive cultures (P = 0.0002), pseudo-aneurysms (P = 0.017), or local signs of sepsis. Phase II--Infected graft model: The 10 surviving infected control dogs served as the established graft infection model. These dogs were randomized into two groups; Group 1 control (N = 5) had the graft replaced; Group 2 treatment (N = 5) had the graft replaced and ANGL treatment. Dogs were sacrificed after 2 weeks.

RESULTS

Graft cultures were positive in all 4 control dogs and negative in the 4 treatment dogs (P = 0.005). One dog in each group was eliminated secondary to failure to obtain graft culture. The data show that ANGL can be effective in the prevention and treatment of prosthetic graft infection.

Bioadhesive and histotoxic properties of ethyl-2-cyanoacrylate

Ethyl-2-cyanoacrylate was applied to the cortex of rabbits to evaluate its bioadhesive and histotoxic behavior. The animals were killed at 4 or 10 days. Half of the animals were pretreated with dexamethasone. Our results indicate that the application of ethyl-2-cyanoacrylate to brain tissue produced severe superficial cortical necrosis but not bioadhesion. Pretreatment with steroids did not provide a significant protective effect.

Experimental investigation of the use of cyano-acrylate adhesive to prevent biliary leakage in percutaneous transhepatic cholangiography

A simple modification of the technique of percutaneous transhepatic cholangiography to prevent leakage of bile or blood has been investigated.

Isobutyl 2-cyano-acrylate monomer has been used to obliterate and seal the tract left when the needle and polythene tube are withdrawn, thus effectively preventing leakage.