Cyanoacrylate for colonic anastomosis; is it safe?

BACKGROUND: This experimental study evaluated the effectiveness and safety of using cyanoacrylate adhesive for sutureless colonic anastomosis and as a protective seal to prevent leakage.

METHODS: Sixty male Sprague-Dawley rats (300 +/- 10 g, 9 weeks old) were divided into three groups: in group I, the anastomosis was sutured in a single layer with 5-0 polypropylene; in group II, the anastomosis was fixed using N-butyl-2-cyanoacrylate (Histoacryl(R)); and in group III, the anastomosis was sutured and then sealed with N-butyl-2-cyanoacrylate. The rats were sacrificed on postoperative day 7. The anastomoses among the three groups were compared by measuring wound infection, anastomotic leakage, anastomotic stricture, adhesion formation, anastomotic bursting pressure, and histological appearance.

RESULTS: No anastomotic leakage was observed in any group. Anastomotic stricture was significantly more extensive in groups II and III (p < 0.001). Bursting pressure was significantly lower in groups II and III (168 +/- 58, 45 +/- 21, and 60 +/- 38 mmHg for groups I to III, respectively, p < 0.001). The severity of inflammatory reactions was significantly greater and collagen deposition was significantly lower in groups II and III (p < 0.05).

CONCLUSIONS: N-butyl-2-cyanoacrylate could be a useful method for sutureless colonic anastomosis based on the absence of anastomotic leakage, but it may impede healing of the colonic anastomosis. In addition, when used to seal sutured colonic anastomoses, cyanoacrylate may have a negative influence on anastomotic healing. The clinical use of N-butyl-2-cyanoacrylate in colonic anastomosis does not appear to be acceptable and safer anastomotic methods or alternative forms of cyanoacrylate should be developed.