A Highly Elastic and Adhesive Gelatin Tissue Sealant for Gastrointestinal Surgery and Colon Anastomosis

BackgroundWe describe the development of a highly elastic and adhesive surgical tissue sealant, based on photochemically crosslinked gelatin, for sealing sutured incisions in the gastrointestinal (GI) tract in a rabbit surgical model and in a canine colon anastomosis study.MethodsThe study included in vitro assessment of mechanical parameters of the tissue sealant and in vivo analysis of burst strength and histology at 24 h, 3 days and 7 days post surgery, in a rabbit model, to assess progress of wound healing at the suture sites. Utility of this sealant to repair and seal a lower colonic resection and anastomosis procedure in a canine model was also investigated.ResultsWe show that a photopolymerised gelatin tissue sealant provides effective sealing of GI incisions and facilitates wound healing with no evidence of inflammation up to 28 days post-surgery. Blending of derivatised gelatin with underivatised gelatin allowed tuning of elasticity and elastic modulus of the photopolymerised sealant to suit surgical applications. High tissue adhesive strength was maintained at all blend ratios and exceeded 100 kPa.ConclusionsThis highly elastic and adhesive photopolymerised gelatin tissue sealant offers a number of advantages over currently available sealants suitable for GI surgical procedures.

[1]  Use of a cross-linked gelatin tissue adhesive in surgery of the urinary tract. , 1967, Surgery, gynecology & obstetrics.

[2]  N. G. Graham,et al.  Anastomotic dehiscence after anterior resection of rectum and sigmoid , 1970, The British journal of surgery.

[3]  W. Hunter,et al.  The labelling of proteins to high specific radioactivities by conjugation to a 125I-containing acylating agent. , 1973, The Biochemical journal.

[4]  A N Smith,et al.  Mechanical properties of the rat colon: the effect of age, sex and different conditions of storage. , 1985, Quarterly journal of experimental physiology.

[5]  R. Simmons,et al.  Fibrin in peritonitis. V. Fibrin inhibits phagocytic killing of Escherichia coli by human polymorphonuclear leukocytes. , 1986, Annals of surgery.

[6]  V. Muntean Fibrin in peritonitis. , 1987, Annals of surgery.

[7]  J. Jeekel,et al.  Effect of fibrin sealant on the healing colonic anastomosis in the rat , 1991, The British journal of surgery.

[8]  L. Påhlman,et al.  Complications after double and single stapling in rectal surgery. , 1991, The European journal of surgery = Acta chirurgica.

[9]  W. Kort,et al.  Healing of ischemic colonic anastomosis: Fibrin sealant does not improve wound healing , 1992, Diseases of the colon and rectum.

[10]  A. Cuschieri,et al.  Adverse influence of fibrin sealant on the healing of high-risk sutured colonic anastomoses. , 1992, Journal of the Royal College of Surgeons of Edinburgh.

[11]  Helen Fox Krause In vitro testing: Editor: Ivor A. Emanuel Thieme Medical Publishers, Inc., New York, 1994 , 1996 .

[12]  Acylation of peptide hydroxyl groups with the Bolton-Hunter reagent. , 1996, Biochemical and biophysical research communications.

[13]  T. Kodadek,et al.  Chemistry for the analysis of protein-protein interactions: rapid and efficient cross-linking triggered by long wavelength light. , 1999, Proceedings of the National Academy of Sciences of the United States of America.

[14]  A. Bigi,et al.  Mechanical and thermal properties of gelatin films at different degrees of glutaraldehyde crosslinking. , 2001, Biomaterials.

[15]  P. Soeters,et al.  Colorectal Surgery and Anastomotic Leakage , 2002, Digestive Surgery.

[16]  D. Torchiana,et al.  BioGlue: Albumin/Glutaraldehyde Sealant in Cardiac Surgery , 2003, Journal of cardiac surgery.

[17]  N J McC Mortensen,et al.  Postoperative leakage and abscess formation after colorectal surgery. , 2004, Best practice & research. Clinical gastroenterology.

[18]  H. Luckraz,et al.  Fatal right ventricular infarction caused by Bioglue coronary embolism. , 2004, The Journal of thoracic and cardiovascular surgery.

[19]  S. Yıldırım,et al.  The effect of tissue adhesive, octyl-cyanoacrylate, on the healing of experimental high-risk and normal colonic anastomoses. , 2004, American journal of surgery.

[20]  P. Campbell,et al.  Evaluation of Absorbable Surgical Sealants : In vitro Testing , 2005 .

[21]  M. Castellà,et al.  Acute limb ischemia due to embolization of biological glue after repair of type A aortic dissection. , 2005, Interactive cardiovascular and thoracic surgery.

[22]  M. Devbhandari,et al.  Acute intraoperative malfunction of aortic valve due to surgical glue. , 2006, The Annals of thoracic surgery.

[23]  S. Kuru,et al.  Early effects of fibrin sealant on colonic anastomosis in rats: an experimental and case-control study , 2006, Techniques in Coloproctology.

[24]  M. Smyth,et al.  Hydrogel-induced cervicomedullary compression after posterior fossa decompression for Chiari malformation. Case report. , 2007, Journal of neurosurgery.

[25]  M. Secic,et al.  Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery: a prospective monocentric study , 2008, International Journal of Colorectal Disease.

[26]  T. Nordentoft,et al.  Sealing of Gastrointestinal Anastomoses with a Fibrin Glue-Coated Collagen Patch: A Safety Study , 2007, Journal of investigative surgery : the official journal of the Academy of Surgical Research.

[27]  N. Artzi,et al.  Viscoelastic adhesive mechanics of aldehyde-mediated soft tissue sealants. , 2008, Biomaterials.

[28]  William S. Pietrzak,et al.  Musculoskeletal tissue regeneration : biological materials and methods , 2008 .

[29]  M. Andrews,et al.  On the mechanical properties of bovine serum albumin (BSA) adhesives , 2008, Journal of materials science. Materials in medicine.

[30]  Douglas M Sidle,et al.  Determination of shear strength of periosteum attached to bone with BioGlue Surgical Adhesive. , 2008, Archives of facial plastic surgery.

[31]  Evaluation of gelatin/resorcinol/aldehyde as a hemostatic agent and tissue adhesive: an experimental study in rat. , 2008, International surgery.

[32]  A. Tekin,et al.  Effects of platelet rich plasma on colonic anastomosis. , 2008, The Journal of surgical research.

[33]  W. Spotnitz Tissue Adhesives: Science, Products, and Clinical Use , 2008 .

[34]  S. Burks,et al.  Hemostats, sealants, and adhesives: components of the surgical toolbox , 2008, Transfusion.

[35]  K. Witter,et al.  Tissue reaction to three different types of tissue glues in an experimental aorta dissection model: a quantitative approach , 2010, Histochemistry and Cell Biology.

[36]  A. Celik,et al.  Effect of n‐Butyl‐2‐Cyanoacrylate on High‐Risk Colonic Anastomoses , 2009, The Kaohsiung journal of medical sciences.

[37]  Y. Matsui,et al.  Optimal proportions of gelatin-resorcin-formalin components in aortic surgery. , 2009, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[38]  A. Azadani,et al.  Mechanical properties of surgical glues used in aortic root replacement. , 2009, The Annals of thoracic surgery.

[39]  T. Kingham,et al.  Colonic anastomotic leak: risk factors, diagnosis, and treatment. , 2009, Journal of the American College of Surgeons.

[40]  D. Campbell,et al.  Mechanical aortic valve dysfunction due to biological glue. , 2009, The Annals of thoracic surgery.

[41]  Gregory F Payne,et al.  Biomimetic sealant based on gelatin and microbial transglutaminase: an initial in vivo investigation. , 2009, Journal of biomedical materials research. Part B, Applied biomaterials.

[42]  A. Diegeler,et al.  Foreign Material Reaction to BioGlue® as a Possible Cause of Cardiac Tamponade , 2010, The Thoracic and cardiovascular surgeon.

[43]  E. Edelman,et al.  Augmentation of postswelling surgical sealant potential of adhesive hydrogels. , 2010, Journal of biomedical materials research. Part A.

[44]  Y. Ho,et al.  Techniques for colorectal anastomosis. , 2010, World journal of gastroenterology.

[45]  G. Dakin,et al.  Surgical adhesive increases burst pressure and seals leaks in stapled gastrojejunostomy. , 2008, Surgery for Obesity and Related Diseases.

[46]  R. Redfern,et al.  Postoperative Cervical Cord Compression Induced by Hydrogel (DuraSeal): A Possible Complication , 2010, Spine.

[47]  Misook Kim,et al.  A highly elastic tissue sealant based on photopolymerised gelatin. , 2010, Biomaterials.

[48]  T. Keck,et al.  Anastomotic Sealing by Extracellular Matrices (ECM) Improves Healing of Colonic Anastomoses in the Critical Early Phase , 2010, Journal of Gastrointestinal Surgery.

[49]  A. Martínez de Alegría,et al.  Pulmonary embolism due to biological glue after repair of type A aortic dissection. , 2011, Interactive cardiovascular and thoracic surgery.