The Effect of Fibrin Glue on the Intensity of Colonic Anastomosis in the Presence and Absence of Peritonitis: An Experimental Randomized Controlled Trial on Rats
Aim. Anastomotic leakage after colon anastomosis is the most frequent and most feared complication with its highest mortality rate. In this study, we aimed to expose the impact of performing fibrin glue on sutured colocolic anastomosis, in the presence of experimental peritonitis, on anastomosis safety. Method. In this experimental study, the rats were divided into two groups as control group (Groups 1 and 3) and experimental group (Groups 2 and 4). They were also divided as clean abdomen (Groups 1 and 2) and infected abdomen (3 and 4) groups. Full-thickness incisions were made on the proximal colon of both groups of rats. The control group’s anastomoses were conducted only with sutures, whereas in experimental group, fibrin glue was applied over the sutures. The samples were taken on the 10th day. Results. Highest values for average levels of hydroxyproline in the tissues and anastomotic bursting pressures were detected when fibrin glue was applied on sutured anastomosis in clean abdomen. In the histopathological staging performed in line with Ehrlich-Hunt model, lowest values were detected during the presence of peritonitis. Conclusion. As a result, it has been established that the use of fibrin glue over sutured colocolic anastomosis, both in clean abdomen and in the presence of peritonitis, had increased anastomosis safety. 1. Introduction In colorectal surgery, intestinal anastomoses are being performed in lots of intestinal pathologies, mainly, malign colon tumors. The complications observed after colon anastomoses are anastomotic leakage, fistula, hemorrhage, and anastomotic stricture. The most common of such complications is anastomotic leakage with its highest morbidity and mortality rates [1]. There are variety of factors besides the surgeon’s lack of experience and skill which can lead to anastomotic complications such as patient’s advanced age, presence of additional diseases such as diabetes mellitus, weight loss, hypotension, urgent operations, and infections [2]. Both in elective and in urgent colon operations, primary anastomosis is being avoided in case of infected abdomen and multistep procedures are preferred [3, 4]. The reason for this is the deterioration of wound recovery in a contaminated environment and high risk of anastomotic leakage [5]. It has to be remembered that performing ostomy instead of anastomosis may cause many complications, loss of work power, and increase in cost and thus burden additional morbidity on patients [4, 6]. Therefore, anastomosis safety has been one of the most studied topics in colorectal surgery. To
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