Sutureless bowel plication. An experimental study using tissue adhesives.

Abstract Postoperative intestinal adhesions continue to be a perplexing problem, particularly in infants. The Noble, transmesenteric, and tube stent plication procedures designed to prevent recurrent episodes of intestinal obstruction are all associated with significant complications. The present study was designed to evaluate the concept of sutureless bowel plication, using tissue adhesive. Sixty-seven of seventy-five rats in (group I) (89 per cent) survived the plication using isobutyl-2-cyanoacrylate tissue adhesive monomer. Kinking of loops producing obstruction occurred in 5 per cent of cases. Although the plicated loops remained in position up to nine months post operation, there was chronic inflammatory infiltrate and persistence of the tissue adhesive monomer. Survival rate for rats in group III undergoing serosal abrasion and adhesive plication was 90 per cent (twenty-seven of thirty) at seven days. This is compared to a survival rate of 77 per cent (twenty-three of thirty) for control animals with serosal abrasion (group II). Histologic examination of rat bowel in group III, however, showed penetration of the tissue adhesive through the injured serosa and muscular coat of the bowel. Simple plication was accomplished in thirty rabbits (group IV) with no deaths or bowel kinking observed. Histologic evaluation demonstrated moderate to severe granulomatous reaction, chronic inflammation, and fibrosis at one and six months after operation. The concept of rapid atraumatic sutureless bowel plication is most attractive and the survival data in plicated groups (89 to 100 per cent) are impressive. However, persistence of the adhesive monomer due to low biodegradability, penetration of the bowel wall in abraded instances, severe granulomatous inflammatory reaction, and the question of carcinogenicity suggest that this technic be limited to further laboratory investigation until the clinical safety of the adhesives is established.