Bioassay of cyanoacrylate tissue adhesives used for intraperitoneal mesh fixation

Glue mesh fixation in laparoscopic sacrocolpopexy: results at 3 years' follow-up

INTRODUCTION AND HYPOTHESIS

We assessed 3-year anatomic and functional results using synthetic glue to fix mesh in laparoscopic sacrocolpopexy.

METHODS

Prospective multicenter cohort study in three academic urogynecology departments. Seventy consecutive patients with stage ≥ 3 POP-Q (Pelvic Organ Prolapse Quantification) anterior and/or apical prolapse underwent laparoscopic sacrocolpopexy using synthetic surgical glue to fix anterior and posterior meshes to the vagina. Patients were followed up at 1, 2 and 3 years. Primary outcome was anterior and apical anatomic success (POP-Q stage ≤ 1) at 3 years. Secondary outcomes comprised functional results (international quality of life and sexuality scales), mesh-related morbidity and urinary incontinence at 3 years.

RESULTS

Mean age was 56.7 ± 1.2 years. Mean follow-up was 43 months. Anterior compartment anatomic success rate was 87% at 2 years (Ba, -2.4 cm; p < 0.0001) and 86.5% at 3 years (Ba, -2.3 cm; p < 0.0001); apical success was 96.3% at 2 years (C, -6.8 cm; p < 0.0001) and 97.3% at 3 years (C, -6.5 cm; p < 0.0001). All quality-of-life scores improved significantly and lastingly at 3 years: PFDI-20, PFIQ-7 and PISQ-12, respectively, p < 0.0001, p < 0.0001 and p = 0.01. There was one case of vaginal mesh exposure at 3 years (2.8%) and five of mesh shrinkage at 1 year (7.8%), none at 2 years and two at 3 years (5.4%). Urinary incontinence rate was 29.7% at 1 year, 14.8% at 2 years and 11.1% at 3 years.

CONCLUSION

Vaginal mesh adhesive in laparoscopic sacrocolpopexy remained effective at 3 years, with excellent tolerance and no specific complications. Anatomic and functional results were good and enduring in terms of both anterior and apical correction.

The cytotoxic properties and apoptotic potential of N-butyl and 2-octyl cyanoacrylates used in surgical treatment of chronic venous insufficiency

Background

This study aims to investigate the cytotoxic effects and apoptotic potential of N-butyl cyanoacrylate and 2-octyl cyanoacrylate used in surgical treatment of chronic venous insufficiency.

Methods

N-butyl cyanoacrylate and 2-octyl cyanoacrylate were cultured in cell-culture using human umbilical endothelial cell-line. Cytotoxicity and viability were assessed at 24 and 72 hours with lactate dehydrogenase and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays, respectively. Apoptotic potential was documented at 24 and 72 hours with relative caspase-3 activity.

Results

The mean cytotoxicity at 24 and 72 hours were: N-butyl cyanoacrylate with an area of dot/line: 37.0±3.9%/29.3±2.7% and 46.4±1.6%/45.1±7.1%, 2-octyl cyanoacrylate with an area of dot/line: 39.0±7.0%/37.3±4.6% and 47.0±2.3%/40.7±7.5%. Cytotoxicity increased by time in each group (p<0.05). The mean viability at 24 and 72 hours were: N-butyl cyanoacrylate with an area of dot/line: 53.4±7.7%/72.0±5.7% and 35.7±1.9%/37.8±3.7%, 2-octyl cyanoacrylate with an area of dot/line: 54.3±4.4%/73.5±19.9% and 33.6±2.8%/30.7±4.5%. The mean viability decreased by time in each group (p<0.05). The mean relative caspase-3 activity at 24 and 72 hours were: control group: 0.084±0.006 and 0.065±0.002, N-butyl cyanoacrylate with an area of dot/line: 0.940±0.037/0.924±0.053 and 0.999±0.072/1.056±0.015, 2-octyl cyanoacrylate with an area of dot/line: 0.900±0.044/0.928±0.018 and 0.989±0.084/0.999±0.072. The mean relative caspase-3 activity was higher than control group in each group at each time interval (p<0.05) and activity increased by time in N-butyl cyanoacrylate line and in 2-octyl cyanoacrylate line groups (p<0.05).

Conclusion

Our findings indicate that N-butyl cyanoacrylate and 2-octyl cyanoacrylate cause cytotoxicity in cell-culture media. We may also postulate that they induce apoptosis in cell-culture media.