Adhesives and adhesions: intestinal surgery on a sticky wicket!

In the healing of incised wounds, specifically in the peritoneal cavity, there is a delicate balance between adherence of the wound edges and adhesions between peritoneal surfaces. For bowel anastomosis, adherence of the wound edges is vital to allow apposition and wound healing and avoid leakage of intraluminal content. The traditional use of sutures and staples has now been augmented by tissue adhesives in an attempt to obtain a more favourable outcome, yet avoid excessive adhesion formation. A tissue adhesive may be defined as a substance that by polymerization will hold tissues together and provide a barrier to leakage. 1 Ideally, the adhesive must maintain approximation long enough for wound healing to occur, then dissolve or be absorbed without hindering the healing process. Safety of the product is vital to minimize adverse events particularly toxic, inflammatory or infectious sequelae. Tissue adhesives in clinical use include: fibrin sealants, albumin-based compounds (glutaraldehyde glues), cyanoacrylates (super glue), hydrogels (polyethylene glycol polymers) and collagen-based adhesives (collagen combined with fibrin). Of these, the fibrin sealants have had by far the widest application in almost all surgical procedures, and in bowel surgery have demonstrated good results in wound healing and reducing adhesions. 2