Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Surgical Endoscopy
Published in: Surgical Endoscopy 11/2008

01-11-2008

The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial

Authors: Gianfranco Silecchia, Cristian Eugeniu Boru, Jean Mouiel, Marco Rossi, Marco Anselmino, Mario Morino, Mario Toppino, Achille Gaspari, Paolo Gentileschi, Roberto Tacchino, Nicola Basso

Published in: Surgical Endoscopy | Issue 11/2008

Login to get access

Abstract

Background

Published interim results have shown that fibrin sealant (Tissucol®/Tisseel® Baxter AG, Vienna, Austria) may be effective in preventing anastomotic leaks and internal hernias following laparoscopic Roux-en-Y gastric bypass (LRYGBP). We report the final results of a multicenter, randomized clinical trial evaluating the use of fibrin sealant in LRYGBP.

Methods

Between January 2004 and December 2005, 340 patients aged 21–65 years with a body mass index (BMI) of 40–59 kg/m2 undergoing LRYGBP were randomized (1:1) to two treatment groups: fibrin sealant group (applied to gastrojejunal and jejunojejunal anastomoses and over mesenteric openings), and control group (no fibrin sealant; suture of the mesenteric openings). Operative time, early and late complications, reinterventions, time to oral diet initiation, and length of stay were assessed.

Results

Overall, 320 patients were included into the study: 160 in the control group and 160 in the fibrin sealant group. All patients completed follow-up assessments at 6 and 12 months, and 60.9% completed assessments at 24 months. There were no significant differences between groups with respect to demographics, operative time, oral diet initiation, hospital stay, and BMI reduction at 6, 12, and 24 months. The incidence of anastomotic leak was numerically, but not significantly, greater in the control group. The overall reintervention rate for specific early complications (<30 days) was significantly higher in the control group (p = 0.016). No deaths or conversions to open laparotomy occurred.

Conclusion

The use of fibrin sealant in laparoscopic RYGBP may be beneficial in reducing the reintervention rate for major perioperative (<30 days) complications. Larger studies are needed.
Literature
1.
Jackson MR (2001) Fibrin sealants in surgical practice: an overview. Am J Surg 182(Suppl.2):S1–S7CrossRef
2.
Tredree R, Beierlein W, Debrix I et al (2006) Evaluating the differences between fibrin sealants: recommendations from an international advisory panel of hospital pharmacists. Eur J Hosp Pharm Sci 12:3–9
3.
4.
Capussotti L, Ferrero A, Vigano L et al (2006) Bile leakage and liver resection. Arch Surg 141:690–694PubMedCrossRef
5.
Sanabria AE, Morales CH, Villegas MI (2005) Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev 4:CD004778PubMed
6.
Kawamura M, Gika M, Izumi Y et al (2005) The sealing effect of fibrin glue against alveolar air leakage evaluated up to 48 h; comparison between different methods of application. Eur J Cardiothorac Surg 28:39–42PubMedCrossRef
7.
Tawil Bill (2006) Fibrin and its applications. In: Guelcher SA, Hollinger JO (eds) An introduction to biomaterials. CRC, Boca Raton, FL pp 105–120
8.
Evans AL, Morrey AF (2006) Current application of fibrin sealant in urologic surgery. Int Braz J Urol 32:131–141PubMedCrossRef
9.
Sapala JA, Wood MH, Chuhknecht MP (2004) Anastomotic leak prophylaxis using a vapour-heated fibrin sealant: Report on 738 gastric bypass patients. Obes Surg 14:35–42PubMedCrossRef
10.
Novik B, Hagedorn S, Mork UB et al (2006) Fibrin glue for securing the mesh in laparoscopic totally extraperitoneal inguinal hernia repair: a study of a 40-month prospective follow-up. Surg Endosc 20:462–467PubMedCrossRef
11.
Olmi S, Scaini A, Erna L et al (2007) Use of fibrin glue (Tissucol®) in laparoscopic repair of abdominal wall defects: preliminary experience. Surg Endosc 21:555–559PubMedCrossRef
12.
Lee FY, Leung KL, Lai PB et al (2001) Selection of patients for laparoscopic repair of perforated peptic ulcer. Br J Surg 88:133–136PubMedCrossRef
13.
Schmal H, Geiger G (2005) Laparoscopic splenic salvage in delayed rupture by application of fibrin glue in a 10-year old boy. J Trauma 58:628–630PubMed
14.
Corcione F, Cuccurullo D, Caiazzo P et al (2003) Laparoscopic partial splenectomy for a splenic pseudocyst. Surg Endosc 17:1850PubMed
15.
Chen RJ, Fang JF, Lin BC et al (1998) Selective application of laparoscopy and fibrin glue in the failure of nonoperative management of blunt hepatic trauma. J Trauma 44:691–695PubMedCrossRef
16.
Belli G, Fantini C, D’Agostino A et al (2005) Laparoscopic hepatic resection for completely exophytic hepatocellular carcinoma on cirrhosis. J Hepatobiliary Pancreat Surg 12:488–493PubMedCrossRef
17.
Takeuchi H, Kitade M, Kikuchi I et al (2005) Adhesion-prevention effects of fibrin sealants after laparoscopy myomectomy determined by second-look laparoscopy: a prospective, randomized, controlled study. J Reprod Med 50:571–577PubMed
18.
Nur I, Lyahovetsky Y, Bar L et al (2005) Commercial fibrin sealants are not equivalent in a rabbit liver-resection model which quantitatively evaluates haemostasis and formation of adhesions. Eur Surg Res 37:159–165PubMedCrossRef
19.
American Society for Gastrointestinal Endoscopy Technology Assessment Committee (2004) Technology status evaluation report: tissue adhesives and fibrin glues. Gastrointest Endosc 60:327–333CrossRef
20.
Liu CD, Glantz GJ, Livingston EH (2003) Fibrin glue as a sealant for high-risk anastomosis in surgery for morbid obesity. Obes Surg 13:45–48PubMedCrossRef
21.
Nguyen NT, Nguyen CT, Stevens CM et al (2004) The efficacy of fibrin sealant in prevention of anastomotic leak after laparoscopic gastric bypass. J Surg Res 122:218–224PubMedCrossRef
22.
Lee MG, Provost DA, Jones DB (2004) Use of fibrin sealant in laparoscopic gastric bypass for morbidly obese. Obes Surg 14:1321–1326PubMedCrossRef
23.
Carbajo M, Garcia-Caballero M, Toledano M et al (2005) One anastomosis gastric bypass by laparoscopy: results of the first 209 patients. Obes Surg 15:398–404PubMedCrossRef
24.
Hutter M, Sheldon R, Khuri S et al (2006) Laparoscopic versus open gastric bypass for morbid obesity: a multicenter, prospective, risk-adjusted analysis from the national surgical quality improvement program. Ann Surg 243:657–666PubMedCrossRef
25.
Higa KD, Tienchin Ho, Boone KB (2003) Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention. Obes Surg 13:350–354PubMedCrossRef
26.
Capella RF, Iannace VA (2006) Bowel obstruction after open and laparoscopic gastric bypass surgery for morbid obesity. J Am Coll Surg 203:328–335PubMedCrossRef
27.
Waage A, Gagner M, Biertho L et al (2005) Comparison between open hand-sewn, laparoscopic stapled and laparoscopic computer-mediated, circular stapled gastro-jejunostomies in Roux-en-Y gastric bypass in the porcine model. Obes Surg 15:782–787PubMedCrossRef
28.
Silecchia G, Boru CE, Mouiel J et al (2006) Clinical evaluation of fibrin glue in the prevention of anastomotic leak and internal hernia after laparoscopic gastric bypass: preliminary results of a prospective, randomized multicenter trial. Obes Surg 16:125–131PubMedCrossRef
29.
Gastrointestinal surgery for severe obesity (1991) National Institutes of Health Consensus Development Conference Draft Statement. Obes Surg 1:257–266CrossRef
30.
Gonzalez R, Nelson LG, Scott F et al (2004) Anastomotic leaks after laparoscopic gastric bypass. Obes Surg 14:1299–1337PubMedCrossRef
31.
Podnos YD, Jiminez JC, Wilson SE et al (2003) Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg 138:957–961PubMedCrossRef
32.
Papavramidis ST, Eleftheriadis EE, Papavramidis TS et al (2004) Endoscopic management of gastrocutaneous fistula after bariatric surgery by using a fibrin sealant. Gastrointest Endosc 59:296–300PubMedCrossRef
33.
Eleftheriadis E, Tzartinoglou E, Kotzampassi K et al (1990) Early endoscopic fibrin sealing of high-output postoperative enterocutaneous fistulas. Acta Chir Scand 156:625–628PubMed
34.
Truong S, Bohm G, Klinge U et al (2004) Results after endoscopic treatment of postoperative gastrointestinal fistulas and leaks using combined Vycril plug and fibrin sealant. Surg Endosc 18:1105–1108PubMedCrossRef
Metadata
Title
The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial
Authors
Gianfranco Silecchia
Cristian Eugeniu Boru
Jean Mouiel
Marco Rossi
Marco Anselmino
Mario Morino
Mario Toppino
Achille Gaspari
Paolo Gentileschi
Roberto Tacchino
Nicola Basso
Publication date
01-11-2008
Publisher
Springer-Verlag
Published in
Surgical Endoscopy / Issue 11/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-008-9885-0

Other articles of this Issue 11/2008

Surgical Endoscopy 11/2008 Go to the issue

Letter

A novel approach to extraction of incarcerated omentum and mesh insertion in laparoscopic ventral hernia repair

OriginalPaper

Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrhoidal artery ligation: functional results after 1-year follow-up

OriginalPaper

Mechanical versus suture fixation of the port in adjustable gastric banding procedures: a prospective randomized blinded study

Review

Does endoscopic retrograde cholangiopancreatography reduce the risk of local pancreatic complications in acute pancreatitis? A systematic review and metaanalysis

OriginalPaper

The effect of extended post-discharge chemical thromboprophylaxis on venous thromboembolism rates after bariatric surgery: a prospective comparison trial

OriginalPaper

Laparoscopic pancreaticoduodenectomy is effective in a porcine model