Effects of cyanoacrylate on leakage pressures of cooled canine cadaveric jejunal enterotomies.

Abstract

OBJECTIVE: To compare the intraluminal initial and maximal pressures of enterotomies closed using three different techniques (single-layer appositional continuous closure; closure with cyanoacrylate; a single-layer appositional closure augmented with cyanoacrylate) in a cooled canine cadaveric jejunal model and to report the initial leak location in all samples. STUDY DESIGN: Experimental, ex-vivo study. SAMPLE POPULATION: Grossly normal chilled small intestine segments from three canine cadavers. METHODS: A total of 45 chilled jejunal segments (n&#x2009;=&#x2009;15&#x2009;segments/group) were assigned to a handsewn group (HSE), a cyanoacrylate only group (CE) and a handsewn and cyanoacrylate group (HS&#x2009;+&#x2009;CE). A 2&#x2009;cm antimesenteric enterotomy was performed and closure with one of the above techniques. Initial leakage pressures (ILP), maximal intraluminal pressures (MIP) and initial leakage location were recorded by a single observer. RESULTS: Handsewn enterotomies leaked at higher ILP when augmented with cyanoacrylate (83.3&#x2009;&#xb1;&#x2009;4.6&#x2009;mmHg, p&#x2009;<&#x2009;.001) compared to both the HSE group (43.8&#x2009;&#xb1;&#x2009;5.3&#x2009;mmHg) and the CE group (18.6&#x2009;&#xb1;&#x2009;3.5&#x2009;mmHg). Those sealed with cyanoacrylate only leaked at a lower MIP compared with the other groups (p&#x2009;<&#x2009;.001). Maximal intraluminal pressures did not differ between handsewn enterotomies, whether augmented or not (p&#x2009;=&#x2009;.19). CONCLUSION: Reinforcement of a sutured enterotomy closure with cyanoacrylate was easy to perform and resulted in significantly increased initial leak pressures in cadaveric jejunum. CLINICAL SIGNIFICANCE: The increased leakage pressures achieved by reinforcing enterotomies with cyanoacrylate could consequently reduce the incidence of postoperative intestinal leakage following an enterotomy and may result in reduced patient morbidity or mortality.