Surg Today Jpn J Surg (1995) 25:1069-1072 @ SURGERYTO~Y © Springer-Verlag 1995 How to Do It The Use of Cyanoacrylate Tissue Adhesive in High-Risk Intestinal Anastomoses GIOVANNI DOMENICO TEBALA, 1 FRANCO CERIATI,1 EMANUELA CERIATI,1 AMORINO VECCHIOLI, 2 and STEFANIANORI 3 Departments of 1 Surgery, 2Radiology, and 3Human Anatomy, Catholic University of the Sacred Heart, L.go Agostino Gemelli, 8, 00168 Rome, Italy Abstract: The success of every intestinal surgical procedure primarily depends on correct technical execution of the intes- tinal sutures. Despite the continuing improvements in intestinal synthesis techniques and the introduction of mechanical stap- lers, the risk of anastomotic dehiscence remains a major concern. For high-risk anastomoses, defined as those per- formed under critical conditions, n-butyl-2-cyanoacrylate tissue adhesive allows for quick sealing of the two stumps and supports the physiological wound-healing process. Further- more, no experimental or clinical studies have shown that this glue has any carcinogenic or mutagenic properties. Thus, we believe that n-butyi-2-cyanoacrylate will be extremely useful for intestinal anastomoses with a high risk of dehiscence. Key Words: cyanoacrylate, tissue adhesive, intestinal anastomoses Introduction Improving intestinal synthesis techniques has become of primary importance in the development of ab- dominal surgery. In fact, since the introduction of antibiotic therapy and modern anesthesia, the results of each intervention of major abdominal surgery depend mostly on the correct application of these techniques. Despite the introduction of staplers and apposition methods (BAR-Valtrac), there is still a high incidence of dehiscence following high-risk an- astomoses, defined as those performed: (a) in an emergency situation, (b) on infected or inflamed tissue, (c) on ischemic stumps, (d) in unsafe anatomical conditions such as the esophagus and low rectum, or (e) in malnourished patients with reduced ability of wound scaring. Therefore, it is necessary to evaluate the surgical methods capable of decreasing the in- Reprint requests to: G.D. Tebala (Received for publication on July 8, 1994; accepted on July 14, 1995) cidence of operative complications related to intestinal suturing under critical conditions. Of particular in- terest are the polymeric glues, most notably the cyanoacrylates, the increasing knowledge about which has foretold their employment in various surgical situations. In this study we analyze the efficacy and patient tolerance of n-butyl-2-cyanoacrylate when employed as a reinforcement for high-risk intestinal anastomoses. Materials and Methods A total of 10 Landrace pigs, weighing 26 + 6 kg, were deprived of food for 2 days after the oral administration of 15 mg magnesium sulphate, but allowed free access to water. After short-term antibiotic prophylaxis, anesthesia was induced by the intramuscular admini- stration of ketamine hydrochloride, 3-4ml, and atro- pine sulfate, 0.5 mg, and maintained by the inhalation of 1.5% halothane and NO2 4-6 1/min. During the operation the animal was infused with 500ml of 10% glucose solution and 500 ml of Ringer's lactate solution intravenously. Through a total xifopubic laparotomy, a limited resection of the colon was performed in 6 pigs and a limited resection of the ileum was performed in 4, followed by a single-layer manual (3-0 silk) or stapled (n.28 EEA) anastomosis, defective for about one-fifth of the circumference (Fig. 1). This artificial dehiscence was then covered with a layer of n-butyl-2-cyanoacrylate (Fig. 2). The animals were deprived of food for 2 days postoperatively, but allowed free access to water, then reoperated on after 15 days, under the previously described general anesthesia. Following lysis of the eventual peritoneal postoperative adhesions, the anastomosed loop was isolated and clamped at both ends. The afferent artery and the efferent vein were