ReviewThe role of tissue adhesives in esophageal surgery, a systematic review of literature

- Tissue adhesives contribute to wound healing by enabling polymerization and forming tight approximation of the anastomosis.
- Two categories of tissue adhesives are used in gastrointestinal surgery: fibrin sealants and cyanoacrylates.
- Included articles mainly documented positive results for the use of tissue adhesives as anastomotic sealants.
- The use of tissue adhesives seems to be a valid treatment option for esophageal fistulas.
- Success of treatment is highly dependent on local expertise.

BackgroundAnastomotic leakage following esophageal surgery is a major contributor to mortality. According to the national database leakage occurs in 20% of esophagectomies carried out in the Netherlands. Therefore anastomotic leakage has been the topic of many studies. However, studies discussing application of tissue adhesives for either prevention or management of anastomotic leakage are limited. This article systematically reviewed all available literature on the potential use of tissue adhesives in esophageal surgery.MethodsMedline, Embase and Cochrane were searched to identify studies that used tissue adhesives as anastomotic sealants to prevent esophageal anastomotic leakage or used tissue adhesives to treat esophageal anastomotic leakage. Two authors independently selected nineteen out of 3107 articles.ResultsEight articles, of which five were experimental and three clinical, discussed prevention of anastomotic leakage. Eleven articles, of which one was experimental and ten clinical, discussed treatment of anastomotic leakage. Most articles reported positive results, however overall quality was low due to a high degree of bias and lack of homogeneity.ConclusionThis study shows mainly positive results for the use of tissue adhesives for the esophageal anastomosis both in prevention of leakage as treating anastomotic leakage. However, the quality of current literature is poor.