Background: Tissue adhesives (TA) may be useful to strengthen colorectal anastomoses, thereby preventing anastomotic leakage (AL). Previous studies have identified cyanoacrylate (CA) TAs as the most promising colonic anastomotic sealants. This study investigates the protective effects of sealing colonic anastomoses with various CAs. Materials and methods: Fifty-five Wistar rats underwent laparotomy and transection of the proximal colon. An anastomosis was created with 4 interrupted sutures followed by either application of Histoacryl Flexible, Omnex, Glubran 2, or no TA seal. An additional control group was included with a 12-suture anastomosis and no TA seal. After 7 days, the rats were sacrificed and scored for the presence of AL as the main outcome. Secondary outcomes were the occurrence of bowel obstruction, adhesions, and anastomotic bursting pressure. Histological evaluation was performed. Results: The highest AL rate was found in the Glubran 2 group (7/11), followed by the 4-sutures group without TA (5/11), and the Omnex group (5/11). Histoacryl Flexible showed the lowest AL rate (2/11). In the control group, only one rat showed signs of AL. Histologically, the highest influx of inflammatory cells was found in the 4-suture group without TA and for Omnex and Glubran 2. Histoacryl Flexible caused more mature collagen deposition when compared to the other TA groups. Conclusions: Histoacryl Flexible showed the lowest leakage rate compared to the other TA groups and to the 4-suture control group. Glubran 2 showed the highest AL rate and a high inflammatory response. Histoacryl Flexible was associated with the presence of more mature collagen and seems to promote anastomotic healing.

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Keywords Anastomosis, Anastomotic leakage, Colorectal surgery, Tissue adhesives
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Journal International Journal of Colorectal Disease: clinical and molecular gastroenterology and surgery
Vakalopoulos, K.A, Bosmans, J.W.A.M. (Joanna W. A. M.), van Barneveld, K.W.Y. (Kevin W. Y.), Vogels, R.R.M. (Ruben R. M.), ter Hoeve-Boersema, G.S.A, Wu, Z, … Lange, J.F. (2017). Impact of tissue adhesives on the prevention of anastomotic leakage of colonic anastomoses: an in vivo study. International Journal of Colorectal Disease: clinical and molecular gastroenterology and surgery, 32(7), 961–965. doi:10.1007/s00384-017-2834-4