Novel synthetic adhesive as an effective alternative to Fibrin based adhesives

AIM To compare a novel, fully synthetic, polyurethane based glue (MAR-1) to fibrin sealant in a partial liver resection rat model. METHODS After 50% resection of the lateral left liver lobe in male Wistar rats (n = 7/group/time point), MAR-1, Fibrin or NaCl was applied. After 14, 21 and 90 postoperative days, sealant degradation, intra-abdominal adhesions were scored, and histological examination of liver tissue was performed. RESULTS (Mean ± SEM) (MAR-1 vs Fibrin vs NaCl). Bleeding mass was significantly higher in NaCl (3.36 ± 0.51 g) compared to MAR-1 (1.44 ± 0.40 g) and Fibrin (1.16 ± 0.32 g). At 14 and 90 d, bleeding time was significantly lower in MAR-1 (6.00 ± 0.9 s; 13.57 ± 3.22 s) and Fibrin (3.00 ± 0.44 s; 22.2 ± 9.75 s) compared to NaCl (158.16 ± 11.36 s; 127.5 ± 23.3 s). ALT levels were significantly higher in MAR-1 (27.66 ± 1 U/L) compared to Fibrin (24.16 ± 0.98 U/L) and NaCl (23.85 ± 0.80 U/L). Intrabdominal adhesions were significantly lower in MAR-1 (11.22% ± 5.5%) compared to NaCl (58.57% ± 11.83%). Degradation of the glue was observed and MAR-1 showed almost no traces of glue in the abdominal cavity as compared to the Fibrin (10% ± 5% 14 d; 7% ± 3% 21 d). Survival showed no significant differences between the groups. CONCLUSION Compared to Fibrin, MAR-1 showed similar hemostatic properties, no adverse effects, and is biocompatible. Further studies on adhesion strength and biodegradability of synthetic sealants are warranted.

[1]  Takayuki Takubo,et al.  Transmission of symptomatic parvovirus B19 infection by fibrin sealant used during surgery , 2000, British journal of haematology.

[2]  K. Woodhouse,et al.  Understanding the biodegradation of polyurethanes: from classical implants to tissue engineering materials. , 2005, Biomaterials.

[3]  Fabian Kiessling,et al.  Hybrid µCT-FMT imaging and image analysis , 2015, Journal of visualized experiments : JoVE.

[4]  R. Rossaint,et al.  Fibrin patch in a pig model with blunt liver injury under severe hypothermia. , 2014, The Journal of surgical research.

[5]  Rolf Lefering,et al.  Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. , 2006, The Journal of trauma.

[6]  A. Singer,et al.  A comparative study of the surgically relevant mechanical characteristics of the topical skin adhesives. , 2012, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[7]  Y. Takeuchi,et al.  Anaphylaxis to aprotinin in fibrin sealant. , 2005, Internal medicine.

[8]  R. Clayman,et al.  Comparison of healing after cystotomy and repair with fibrin glue and sutured closure in the porcine model. , 2008, Journal of endourology.

[9]  P. Coulthard,et al.  Closure of long surgical incisions with a new formulation of 2-octylcyanoacrylate tissue adhesive versus commercially available methods. , 2004, American journal of surgery.

[10]  A. Oswald,et al.  Fatal intraoperative anaphylaxis related to aprotinin after local application of fibrin glue. , 2003, Anesthesiology.

[11]  Bantayehu Sileshi,et al.  A Comprehensive Review of Topical Hemostatic Agents: Efficacy and Recommendations for Use , 2010, Annals of surgery.

[12]  M. Parker,et al.  Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study , 1999, The Lancet.

[13]  M. Pinto,et al.  Development of a biodegradable bioadhesive containing urethane groups , 2008, Journal of materials science. Materials in medicine.

[14]  Liqun Zhang,et al.  Recent Advances in Synthetic Bioelastomers , 2009, International journal of molecular sciences.

[15]  J. A. Sapala,et al.  Anastomotic Leak Prophylaxis Using a Vapor-Heated Fibrin Sealant: Report on 738 Gastric Bypass Patients , 2004, Obesity surgery.

[16]  M. Sacks,et al.  Biodegradable poly(ether ester urethane)urea elastomers based on poly(ether ester) triblock copolymers and putrescine: synthesis, characterization and cytocompatibility. , 2004, Biomaterials.

[17]  H. Horinouchi,et al.  Frequency of transmission of human parvovirus B19 infection by fibrin sealant used during thoracic surgery. , 2002, The Annals of thoracic surgery.

[18]  B. Horowitz,et al.  Estimating the pathogen safety of manufactured human plasma products: application to fibrin sealants and to thrombin , 2008, Transfusion.

[19]  P. Feiss,et al.  [Anaphylactic shock caused by fibrin glue]. , 1997, Annales francaises d'anesthesie et de reanimation.

[20]  M. Musella,et al.  The laparoscopic mini-gastric bypass: the Italian experience: outcomes from 974 consecutive cases in a multicenter review , 2013, Surgical Endoscopy.

[21]  R. Dhanasekaran,et al.  Hepatocellular carcinoma: current trends in worldwide epidemiology, risk factors, diagnosis, and therapeutics , 2012, Hepatic medicine : evidence and research.

[22]  E. Bayram,et al.  Effects of primary suture and fibrin sealant on hemostasis and liver regeneration in an experimental liver injury. , 2008, World journal of gastroenterology.

[23]  Zhifei Chen,et al.  Biodegradable block poly(ester-urethane)s based on poly(3-hydroxybutyrate-co-4-hydroxybutyrate) copolymers. , 2011, Biomaterials.

[24]  M. R. Jackson,et al.  Fibrin sealants in surgical practice: An overview. , 2001, American journal of surgery.

[25]  Fabrizio Romano,et al.  Bleeding in Hepatic Surgery: Sorting through Methods to Prevent It , 2012, HPB surgery : a world journal of hepatic, pancreatic and biliary surgery.

[26]  Fabian Kiessling,et al.  Imalytics Preclinical: Interactive Analysis of Biomedical Volume Data , 2016, Theranostics.

[27]  P. Cahalan,et al.  Factors and Interactions Affecting the Performance of Polyurethane Elastomers in Medical Devices , 1988, Journal of biomaterials applications.

[28]  S. Burks,et al.  Safety and usability of hemostats, sealants, and adhesives. , 2014, AORN journal.

[29]  N. Ahmed,et al.  Management of liver trauma in adults , 2011, Journal of emergencies, trauma, and shock.

[30]  Sylwester Gogolewski,et al.  Preparation, degradation, and calcification of biodegradable polyurethane foams for bone graft substitutes. , 2003, Journal of biomedical materials research. Part A.

[31]  S. Guelcher,et al.  Synthesis, in vitro degradation, and mechanical properties of two-component poly(ester urethane)urea scaffolds: effects of water and polyol composition. , 2007, Tissue engineering.

[32]  A. Guillaume,et al.  Choc anaphylactique à la colle biologique , 1997 .

[33]  A. Barbul,et al.  Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment. , 2015, Current problems in surgery.

[34]  Jonathan E. Didier,et al.  Synthesis and in vitro biocompatibility of injectable polyurethane foam scaffolds. , 2006, Tissue engineering.

[35]  A. Khademhosseini,et al.  Elastic sealants for surgical applications. , 2015, European journal of pharmaceutics and biopharmaceutics : official journal of Arbeitsgemeinschaft fur Pharmazeutische Verfahrenstechnik e.V.

[36]  W D Spotnitz,et al.  Commercial fibrin sealants in surgical care. , 2001, American journal of surgery.

[37]  A. Peitzman,et al.  Liver trauma: WSES position paper , 2015, World Journal of Emergency Surgery.