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Vol. 33. Issue 3.
Pages 174-178 (July - September 2013)
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Vol. 33. Issue 3.
Pages 174-178 (July - September 2013)
Technical Note
DOI: 10.1016/j.jcol.2013.08.004
Open Access
Human fibrinogen and thrombin patch for extraluminal protection of intestinal anastomosis
Membrana de fibrinogênio e trombina humanos para proteção extraluminal de anastomoses intestinais
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Paulo Gustavo Kotzea,
Corresponding author
pgkotze@hotmail.com

Corresponding author.
, Ivan Folchini de Barcelosa, Renato Vismara Ropelatoa, Claudio Saddy Rodrigues Coyb
a Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba, PR, Brazil
b Colorectal Surgery Unit, Campinas State University (UNICAMP), Campinas, SP, Brazil
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Abstract

In spite of recent advances regarding equipment and surgical techniques in colorectal surgery, rates of anastomotic dehiscence (AD) have remained stable throughout the years. The development of products to protect anastomosis aiming the reduction of AD rates has shown to be promising. Human fibrinogen and thrombin patch (HFTP Tachosil®) have been used in experimental studies in animals and small case series in humans, with promising results. In this study, the authors describe the technique of HFTP use in details, aiming the protection of colorectal anastomosis, and retrospectively demonstrate the preliminary results in a pilot case series. HFTP was used in 4 patients submitted to conventional surgery. The procedures performed were: left colon resection, segmental colectomy (both for colorectal cancer), enteral anastomosis for fistula closure and right ileocolectomy. Anastomotic healing and absence of complications were observed in 3 patients, and the patient submitted to right ileocolectomy developed AD and died after reoperation. The use of HFTP is safe and can be indicated in selected cases. However, AD can occur even after the use of this strategy. Randomized controlled trials with larger samples of patients are needed in order to properly define the real benefits of this strategy in dehiscence prevention

Keywords:
Anastomosis surgical
Colorectal surgery
Dehiscence surgical wound
Resumo

Apesar dos avanços em equipamentos e técnica cirúrgica na cirurgia colorretal, os índices de deiscência de anastomose (DA) tem permanecido estáveis nos últimos anos. O desenvolvimento de produtos que visam proteção das anastomoses para redução das taxas de DA tem se mostrado promissor. A membrana de fibrinogênio e trombina humanos (MFTH) vem sendo utilizada em estudos experimentais e em pequenas séries de casos em humanos, com resultados promissores. Neste artigo os autores detalham a descrição técnica da utilização da MFTH na proteção de anastomoses colorretais, e demonstram os resultados preliminares em uma série de casos inicial, de forma retrospectiva. A MFTH foi utilizada em 4 pacientes para proteção das anastomoses, todos operados por via de acesso convencional. Os procedimentos realizados foram: retossigmoidectomia abdominal, colectomia segmentar, enteroanastomose para fechamento de fístula enteral e ileocolectomia direita. Observou-se cicatrização das anastomoses em 3 casos, e DA com necessidade de reoperação e óbito no paciente submetido a ileocolectomia direita. A utilização da MFTH para proteção de anastomoses colorretais é segura, e pode ser utilizada em casos selecionados. DA pode ocorrer mesmo com a utilização da membrana. Aguarda-se estudos randomizados e controlados com maior amostragem de pacientes para se avaliar o real papel dessa estratégia na prevenção da deiscência.

Palavras-chave:
Anastomose cirúrgica
Cirurgia colorretal
Deiscência da ferida operatória
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Copyright © 2013. Sociedade Brasileira de Coloproctologia
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