Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study

Daniela Rega; Ernesto De Giulio; Raffaele De Luca; Andrea Muratore; Marco Milone; Giuseppe Sica; Paolo Millo; Carmela Cervone; Nicola Cillara; Patrizia Marsanic; Brunella Maria Pirozzi; Valeria Grazia Malagnino; Pietro Anoldo; Marcello Calabrò; Giovanni De Palma; Michele Simone; Paolo Delrio

doi:10.3393/ac.2024.00899.0128

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Original Article Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study: Daniela Rega¹, Ernesto De Giulio², Raffaele De Luca³, Andrea Muratore⁴, Marco Milone⁵, Giuseppe Sica⁶, Paolo Millo⁷, Carmela Cervone¹, Nicola Cillara⁸, Patrizia Marsanic⁴, Brunella Maria Pirozzi⁶, Valeria Grazia Malagnino⁹, Pietro Anoldo⁵, Marcello Calabrò⁴, Giovanni De Palma⁵, Michele Simone³, Paolo Delrio¹; DOI: https://doi.org/10.3393/ac.2024.00899.0128
Published online: June 4, 2025

¹Division of Colorectal Surgical Oncology, Department of Abdominal Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy

²Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy

³Department of Surgical Oncology, Istituto Tumori "Giovanni Paolo II" IRCCS, Bari, Italy

⁴Department of General Surgery, E. Agnelli Hospital, Pinerolo, Italy

⁵Department of Clinical and Surgical Gastrointestinal Diseases, University of Naples Federico II, Naples, Italy

⁶Minimally Invasive and Gastrointestinal Surgery Unit, Università e Policlinico Tor Vergata, Rome, Italy

⁷Department of General Surgery, Parini Hospital, Aosta, Italy

⁸Department of Surgery, Santissima Trinità Hospital, Cagliari, Italy

⁹Department of Radiology, Istituto Tumori "Giovanni Paolo II" IRCCS, Bari, Italy

Correspondence to: Daniela Rega, MD Division of Colorectal Surgical Oncology, Department of Abdominal Oncology, Istituto Nazionale Tumori IRCSS "Fondazione G. Pascale", 52 Via Mariano Semmola, Naples 80131, Italy Email: d.rega@istitutotumori.na.it

• Received: December 3, 2024 • Revised: January 12, 2025 • Accepted: February 9, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Graphical abstract
INTRODUCTION
METHODS
RESULTS
DISCUSSION
ARTICLE INFORMATION
REFERENCES

Abstract

Purpose
Anastomotic leaks (AL) remain a major complication following right colectomy for colon cancer. This multicenter, prospective, observational study evaluated the efficacy of Glubran 2, a cyanoacrylate-based sealant, in reducing the incidence of AL by reinforcing ileocolic anastomoses.
Methods
The study enrolled 380 patients undergoing right colectomy for colon cancer across 7 Italian hospitals. Glubran 2 was applied to reinforce ileocolic anastomoses. The primary endpoint was a 50% reduction in AL incidence from a baseline of 6.18% within 10 days after surgery. Secondary endpoints included examining the correlation between AL and preexisting risk factors and determining the rate of anastomotic bleeding. Statistical analyses employed binomial tests and logistic regression.
Results
The AL rate was reduced to 1.85% compared to the reference rate of 6.18% (P<0.01). Glubran 2 exhibited a protective effect even in patients with preexisting risk factors such as smoking, diabetes, or prior surgeries; none of these factors was significantly associated with AL (P>0.05). Surgical technique (P=0.687), anastomosis technique (P=0.998), and anastomosis type (P=0.998) did not influence AL rates. Operation time was similar across groups (P=0.613), and anastomotic bleeding occurred in 1.3% of cases, with no association with AL (P=0.989).
Conclusion
Glubran 2 was safely applied to ileocolic anastomoses, significantly reducing AL rates and potentially providing a protective effect even in patients with known risk factors. Its hemostatic and bacteriostatic properties support improved postoperative outcomes, highlighting its potential as an effective adjunct in colorectal surgery. Further studies are warranted to confirm these findings and explore broader applications.
Keywords: Colonic neoplasms; Surgical anastomosis; Anastomotic leak; Cyanoacrylates; Colectomy

Graphical abstract

INTRODUCTION

Minimally invasive surgery has become the gold standard for resectable colorectal cancer, resulting in improved short-term surgical outcomes [1–4]. However, anastomotic leak (AL) remains a significant complication in colorectal surgery regardless of the approach, leading to prolonged hospital stays and increased costs [5–7]. AL is responsible for up to 30% of postoperative mortality, primarily due to peritonitis, septic shock, and multiple organ failure [8]. In addition, AL negatively impacts long-term oncologic outcomes by increasing local recurrence rates and delaying adjuvant chemotherapy [9, 10]. Reported AL incidence after colorectal surgery ranges from 1.5% to 28% [11, 12], partly due to differences in AL definitions [5]. Numerous risk factors are associated with AL, including preoperative malnutrition, high body mass index, corticosteroid use, prolonged operative times, and the number of stapler firings [13, 14]. However, only some of these risk factors can be modified to reduce the risk of anastomotic failure. Recently, new technologies and techniques—such as advanced staplers and blood perfusion assessment using indocyanine green fluorescence—have been implemented to mitigate AL risk [15–18]. In contrast, data on the use of sealants, such as fibrin glue or cyanoacrylate-based glue like Glubran 2 (GEM Srl), for reinforcing anastomotic sutures remain scarce [19].

The rationale for using sealants is based on the natural repair mechanisms of intestinal anastomoses. These mechanisms involve an inflammatory cascade with collagenase activity and local collagen formation, processes that may temporarily compromise tissue integrity during healing [20, 21]. This critical phase, which is especially vulnerable between the fifth and seventh postoperative days, marks the transition to the proliferative phase of collagen scar formation. Consequently, the seventh postoperative day is particularly critical for potential anastomotic dehiscence [22].

Glubran 2 is a surgical medical device consisting of a synthetic liquid with a cyanoacrylate base modified by an additional monomer provided by the manufacturer [23]. It is designed for use on tissues, providing adhesive, sealing, hemostatic, sclerosing, and embolizing properties. In addition, it functions as a bacteriostatic agent, inhibiting bacterial proliferation without having a bactericidal effect. It is not a substitute for systemic antibiotics. Its bacteriostatic action persists for approximately 7 to 10 days, thereby supporting tissue healing and reducing the risk of further bacterial contamination.

The product can be applied to a variety of tissues, including muscle, bone, cartilage, endothelial, adipose, and connective tissues, as well as internal epithelia, parenchyma, mucous membranes, and serous membranes (such as the peritoneum and pleura). It reacts with all body fluids, including blood, lymph, bile, gastric juice, and pancreatic juice.

Glubran 2 is indicated for use as a sealant to reinforce gastrointestinal and rectal anastomoses. Experimental results suggest that Glubran 2 effectively reinforces intestinal anastomoses. When applied after anastomosis formation, it rapidly polymerizes, sealing suture gaps while providing adhesive, hemostatic, and bacteriostatic properties [24].

This prospective observational multicenter study aims to evaluate the role of Glubran 2 in preventing leaks at ileocolic anastomoses following right colectomy for cancer.

METHODS

Ethics statement

The study protocol was preregistered at ClinicalTrials.gov (identifier: NCT03380858) [25]. The study was approved by the ethics committees of all participating hospitals and informed consent for the publication of the research details and clinical images was obtained from the patients prior to the study.

Study design and objective

This multicenter, prospective, observational study included all consecutive patients who underwent right colectomy for cancer with ileocolic anastomosis reinforced using Glubran 2, from December 2017 to June 2022. Participants were recruited from 7 third-level national hospitals across Italy: Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (Naples, Italy), Istituto Tumori "Giovanni Paolo II" IRCCS (Bari, Italy), E. Agnelli Hospital (Pinerolo, Italy), University of Naples Federico II (Naples, Italy), University of Rome Tor Vergata (Rome, Italy), U. Parini Hospital (Aosta, Italy), and Santissima Trinità Hospital (Cagliari, Italy). Inclusion criteria comprised patients aged 18 years or older undergoing elective right colonic resection for cancer with ileocolic anastomosis, with informed consent obtained. Cases involving intestinal obstruction were excluded because the study focused on elective procedures.

Intravenous prophylactic antibiotics were administered 30 to 60 minutes before surgery, and no mechanical bowel preparation was used, in accordance with Enhanced Recovery After Surgery (ERAS) Society recommendations [26].

AL was defined and graded according to the criteria established by the International Study Group of Rectal Cancer (ISREC) and as classified by Rahbari et al. [27]. Briefly, AL was defined as a defect in the integrity of the intestinal wall at the ileocolic anastomotic site, resulting in a communication between the intraluminal and extraluminal compartments. Diagnosis was based on clinical signs (such as pain, fever, tachycardia, peritonitis, and/or enteric or purulent drainage), radiological findings (e.g., fluid or gas collections on computed tomography scan), and intraoperative evidence (such as enteric spillage or disruption of the anastomotic suture line). Anastomotic bleeding was recorded when it necessitated blood transfusion or active treatment.

The primary aim of the study was to assess the impact of Glubran 2 on AL. The sample size calculation targeted 80% study power, 95% 2-sided confidence intervals (CIs), and accounted for a 4% drop-out rate, under the assumption of a 50% reduction in AL incidence with Glubran 2 application. This calculation resulted in a minimum required sample of 390 patients. Historical AL rates were used for this calculation, drawing from studies published prior to the research period. Specifically, the baseline AL incidence of 6.18% was derived from a study by Hammond et al. [28], which included 99,879 patients who underwent colorectal surgery in the United States between January 2008 and December 2010. Although these data were based on a US cohort, they are considered relevant for our study population. The research was conducted from 2018 to 2022, with a significant interruption due to the COVID-19 pandemic. During this period, recent European studies consistently reported AL rates ranging from 3.2% to 12% for ileocolic anastomoses [29–31]. Consequently, the 6.18% AL rate used for the sample size calculation aligns with recent international evidence and provides a reasonable baseline for comparison.

Endpoints

The primary endpoint of the study was to evaluate the reduction in AL rate within 10 days after surgery. Secondary endpoints included assessing the correlation of AL with preexisting risk factors and determining the rate of anastomotic bleeding.

Data collection

Demographic, surgical, and clinical data were collected prospectively. Preoperative prognostic factors were identified based on literature review and expert opinion. These factors included smoking, alcohol consumption, a Nutritional Risk Score (NRS) of ≥3, diabetes, vascular disease, previous intestinal surgery, preoperative chemotherapy, use of anticoagulant or antiaggregant therapies, immunotherapy, and chronic nonsteroidal anti-inflammatory drug (NSAID) use [8, 10, 11, 32, 33]. Nutritional status was assessed using the NRS tool [34]. Postoperatively, patients were examined daily, and any adverse events were recorded and graded. Morbidity was defined as any deviation from the expected postoperative course, with complications classified according to the Clavien-Dindo system [35].

Anastomosis reinforcement

Glubran 2 was applied to the ileocolic anastomosis using a dedicated nebulizer designed for open, laparoscopic, or robotic surgery. The sealant was nebulized in small quantities to form a thin, flexible film over the anastomosis. The product sets within 60 to 90 seconds, providing mechanical strength without additional adhesive properties (Fig. 1).

Statistical analysis

Continuous data were presented as mean±standard deviation or median (interquartile range), and categorical data as frequencies. The chi-square test was used to assess categorical variables, and the relative risk was reported where applicable. Logistic regression was employed to analyze prognostic factors related to AL; the 95% CI for the incidence of anastomotic fistulae (7 events out of 380 subjects, 1.85%) was calculated using the exact binomial (Clopper-Pearson) method. Statistical significance was set at P<0.05. Data were pseudonymized, and the statistical analysis was performed using IBM SPSS ver. 23.0 (IBM Corp).

RESULTS

Between December 2017 and June 2022, 423 patients were screened. Of these, 42 were excluded because the anastomotic site was not ileocolic, and 1 patient was excluded due to missing data, resulting in a final sample size of 380 subjects (Fig. 2). Recruitment ceased once the prespecified sample size was reached. Demographic and clinical characteristics are summarized in Table 1. The mean age was 70 years, with 203 male patients (53.4%). Overweight or obese individuals comprised 58.6% of the cohort, with a mean body mass index of 26.6 kg/m². The majority of patients were classified as American Society of Anesthesiologists (ASA) physical status III or IV (211 patients, 55.5%). Only 2 patients (0.5%) had an NRS of ≥3. The raw data are available from Zenodo (https://zenodo.org/records/15387506).

Surgical data

Surgical procedures were performed using open (40.5%), laparoscopic (52.1%), or robotic (7.1%) approaches (Table 2). Most anastomoses were created with mechanical staplers (98.4%), while handsewn anastomoses accounted for 5 cases (1.3%). The anastomosis types were side-to-side in 293 cases (77.1%), end-to-side in 81 (21.3%), and end-to-end in 5 (1.3%). Intraoperative complications occurred in 2 cases—one due to bleeding and the other due to technical issues related to excessive visceral fat. The mean operation time was 148.8±59.6 minutes. A diverting stoma was constructed in 8 patients (2.1%), and abdominal drainage was used in 251 cases (66.1%).

Postoperative data

Postoperative outcomes are summarized in Table 3. There were 3 postoperative deaths (0.8%), none of which were attributed to AL. Severe postoperative complications (Clavien-Dindo grade ≥III) occurred in 27 patients (7.1%). Anastomotic fistulae were observed in 7 of 380 patients (1.85%; 95% CI, 1.0%–3.8%) treated with Glubran 2, with 5 cases classified as grade C AL and 2 cases as grade A. Postoperative infections occurred in 15 patients (3.9%), and anastomotic bleeding was observed in 5 cases (1.3%).

Analysis results

The exact binomial test demonstrated that the incidence of AL formation in this cohort (1.85%) was significantly lower than the reference rate of 6.18% (P<0.01). There was no significant correlation between ALs and preexisting risk factors (Table 4). Specifically, logistic regression analysis revealed no association between AL and the following preoperative factors: smoking status (P=0.956), alcohol consumption (P=0.979), NRS ≥3 (P=0.847), diabetes (P=0.958), vascular disease (P=0.353), previous intestinal interventions (P=0.632), preoperative chemotherapy (P=0.979), anticoagulant therapy (P=0.963), antiaggregant therapy (P=0.957), immunotherapy (P=0.995), and chronic NSAID use (P=0.991) (Table 5). Additionally, no significant associations were found between AL and the surgical technique (P=0.687), anastomosis technique (P=0.998), or anastomosis type (P=0.998). Operation time did not significantly differ between patients with and without leakage (P=0.613). Notably, both patients who experienced intraoperative complications developed anastomotic dehiscence (P=0.005). Anastomotic bleeding was not associated with AL (P=0.989).

DISCUSSION

AL remains a major concern in colorectal surgery, affecting clinical outcomes and increasing hospital costs. Managing anastomotic dehiscence—which entails prolonged hospital stays, higher morbidity, and potential reoperations—can be 2 to 5 times more expensive than managing an uncomplicated postoperative course [36]. Prevention efforts focus on identifying and mitigating risk factors. Key intraoperative considerations include tension on the anastomosis, hypoperfusion of anastomotic stumps, intraoperative complications, and surgical durations exceeding 4 hours [37–39]. Various reinforcement techniques—such as interrupted sutures, collagen patches, fibrin glues, and omentoplasty—have been proposed, though with variable results [40, 41]. Applying sealants to the anastomosis aims to protect it during the critical postoperative period for tissue repair, particularly between the fifth and seventh days when new collagen is formed. Although the role of cyanoacrylate glue in reinforcing intestinal anastomoses has been studied, the evidence remains inconclusive [42, 43].

Glubran 2 exhibits pronounced sealing, adhesive, and hemostatic properties. It is a ready-to-use, transparent, light-yellow liquid that rapidly cures (within 60–90 seconds) upon contact with living tissue in a humid environment. The curing process creates a thin, elastic film with high tensile strength that ensures robust tissue adhesion. This film conforms naturally to the tissue’s anatomy, remains impermeable, and is resistant to degradation by blood and other body fluids. It can be easily pierced by a suture needle. Once cured, the film loses its adhesive properties, preventing unwanted adhesions between tissues and intestinal loops. The film is eventually resorbed through hydrolytic degradation over a period ranging from 1 to 6 months, depending on the tissue type and the amount of Glubran 2 applied. Additionally, the polymerization reaction generates a maximum temperature of approximately 45 °C, which does not cause tissue necrosis.

Glubran 2 can be applied in a sprayed form using dedicated accessory devices for both laparoscopic/robotic and open (laparotomic) procedures. Spraying allows an even application, forming a thin, elastic film that adheres to the tissue while preserving its softness. Therefore, for intestinal anastomoses, it is advisable to use these user-friendly devices to apply the product.

Preclinical studies have demonstrated that Glubran 2 effectively enhances anastomotic burst pressure, even when applied without a stapler, yielding results comparable to those achieved with mechanical sutures [24, 44].

Our multicenter, prospective, observational single-arm study aimed to assess the role of Glubran 2 in reducing the risk of AL in ileocolic anastomoses. We chose this sealant for 3 key characteristics: it is synthetic and forms an impermeable yet breathable membrane; it is highly adhesive, ensuring it remains firmly attached to the tissue and continues to provide an effective seal; and it degrades slowly. The slow degradation is particularly beneficial, as it allows the product to remain on the anastomosis for an extended period, facilitating physiological tissue repair without interfering with the healing process. Thus, the continuous external sealing provided by Glubran 2 protects the anastomosis, reinforces it, and acts as a barrier against leakage.

We enrolled 380 patients and applied Glubran 2 to the suture line immediately after anastomosis formation. The observed AL rate was 1.85%, significantly lower than the preset target rate of 6.18% (P<0.01). Our analysis revealed no significant correlation between AL and various preexisting risk factors. Specifically, factors such as smoking, alcohol consumption, NRS ≥3, type II diabetes mellitus, vascular disease, previous intestinal interventions, preoperative chemotherapy, anticoagulant or antiaggregant therapy, immunotherapy, and chronic NSAID use did not show a statistically significant association with AL. While the low incidence of AL and the sample size might have influenced these findings, it is also possible that Glubran 2 effectively mitigates the risk of AL irrespective of these preoperative factors.

However, AL was observed in both patients who experienced intraoperative complications (P=0.005); 1 case was associated with intraoperative bleeding and the other with technical difficulties due to excessive visceral fat. This finding underscores that while Glubran 2 may reduce the overall incidence of AL, intraoperative complications remain a significant risk factor.

Glubran 2 also appeared to close gaps between sutures, potentially contributing to its hemostatic and bacteriostatic effects. This is supported by the low rates of postoperative anastomotic bleeding (1.3%) and infection (3.9%) observed in our study. Notably, the literature reports anastomotic bleeding rates of approximately 3.6% after right colectomy, and postoperative infection rates ranging from 4% to 14% [17, 45].

Despite these positive findings, several limitations should be acknowledged. One major limitation is the reliance on a historical cohort for comparison of AL rates. The baseline AL rate of 6.18% used for sample size calculation was derived from a study by Hammond et al. [28], which involved a large cohort of patients undergoing colorectal surgery in the United States between 2008 and 2010. Although the study was conducted in a different country, we believe the historical data remain relevant because they represent the general colorectal surgery population.

Furthermore, during the period of our study (2018–2022), numerous European studies consistently reported AL rates ranging from 3.2% to 12%, particularly for ileocolic anastomoses, which is the focus of our study [29–31]. Thus, the 6.18% baseline AL rate used for sample size calculation aligns with recent international literature and supports the validity of our findings.

Despite the reliance on historical data, the 6.18% rate remains an appropriate reference point, ensuring that our study was sufficiently powered to detect meaningful differences in AL incidence. Future studies might benefit from using more region-specific data to further refine the risk profile of AL in similar cohorts.

We acknowledge that the single-arm, prospective, observational design of our study limits the ability to directly compare outcomes between patients receiving Glubran 2 and those not receiving it. The primary goal was to evaluate the safety and effectiveness of Glubran 2 in patients undergoing right colectomy, and our results are based on this specific cohort. We recognize that a comparative, controlled study would yield stronger evidence. Future research should include a control group to provide more robust statistical comparisons.

Additionally, future research should compare the efficacy of Glubran 2 across different anastomotic sites. Further studies are needed to confirm the impact of this synthetic glue on various types of intestinal anastomoses and to more comprehensively explore its hemostatic and bacteriostatic properties.

Overall, our study is the first to evaluate Glubran 2 in a large cohort of patients undergoing ileocolic anastomosis, demonstrating its safety, efficacy, and potential cost benefits. Glubran 2 is well-aligned with minimally invasive surgery principles, proving suitable for both handsewn and mechanical anastomoses, and applicable to laparoscopic and robotic procedures, which accounted for 59.3% of our cases.

In conclusion, Glubran 2 appears to be a promising tool for reinforcing ileocolic anastomoses, effectively reducing AL without being influenced by preexisting risk factors. Larger, prospective trials are needed to further validate these findings and address the limitations of our study, particularly regarding comparative methods and the full spectrum of the glue’s properties.

ARTICLE INFORMATION

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Funding

None.

Author contributions

Conceptualization: DR, PD; Data curation: CC, NC, BMP, VGM, PA, MC, GDP, MS; Formal analysis: DR, EDG; Investigation: DR, EDG, RDL; Methodology: DR, PD; Validation: AM, MM, GS, P Millo, P Marsanic; Project administration: DR, PD, RDL; Visualization: DR, EDG; Writing–original draft: DR, EDG; Writing–review & editing: all authors. All authors read and approved the final manuscript.

Fig. 1.

Application of Glubran 2 (GEM) to an ileocolic anastomosis with a dedicated nebulizer.

Fig. 2.

Study flowchart.

Table 1.

Demographic and clinical characteristics of the cohort (n=380)

Characteristic	Value
Age (yr)	70±11
Sex
Male	203 (53.4)
Female	177 (46.6)
Body mass index (kg/m²)	26.6 ± 4.2
ASA physical status
I, II	169 (44.5)
III, IV	211 (55.5)
Smoking status
No	299 (78.7)
Yes	81 (21.3)
Alcohol and psychotropic abuse
No	357 (93.9)
Yes	23 (6.1)
Type II diabetes mellitus
No	310 (81.6)
Yes	70 (18.4)
Malnutrition (NRS ≥3)	2 (0.5)
Vascular disease
No	258 (67.9)
Yes	122 (32.1)
NSAID use
No	374 (98.4)
Yes	6 (1.6)
Antiaggregant therapy
No	302 (79.5)
Yes	78 (20.5)
Anticoagulant therapy
No	322 (84.7)
Yes	58 (15.3)
Chemotherapy
No	363 (95.5)
Yes	17 (4.5)
Previous intestinal surgery
No	296 (77.9)
Yes	84 (22.1)

Values are presented as mean±standard deviation or number (%).

ASA, American Society of Anesthesiologists; NRS, numeric rating scale; NSAID, nonsteroid anti-inflammatory drug.

Table 2.

Surgical procedure data (n=380)

Variable	Value
Surgical technique
Open	154 (40.5)
Laparoscopy	198 (52.1)
Robotic	27 (7.1)
Missing	1 (0.3)
Type of anastomosis
Side-to-side	293 (77.1)
End-to-side	81 (21.3)
End-to-end	5 (1.3)
Missing	1 (0.3)
Anastomosis technique
Mechanic	374 (98.4)
Stapler linear	286 (75.3)
Stapler circular	88 (23.2)
Handsewn	5 (1.3)
Missing	1 (0.3)
Abdominal drainage
No	128 (33.7)
Yes	251 (66.1)
Missing	1 (0.3)
Fecal diversion
No	371 (97.6)
Yes	8 (2.1)
Missing	1 (0.3)
Operation time (min)	148.8±59.6

Values are presented as number (%) or standard deviation. Percentages may not total 100 due to rounding.

Table 3.

Postoperative outcome and morbidity data (n=380)

Outcome	No. of patients (%)
Postoperative mortality	3 (0.8)
Clavien-Dindo classification
No complications	270 (71.1)
≤II	83 (21.8)
≥III	27 (7.1)
Anastomotic leak	7 (1.8)
Grade A	2/7 (28.6)
Grade C	5/7 (71.4)
Anastomotic bleeding	5 (1.3)
Infection	15 (3.9)
Intrabdominal fluid	11 (2.9)

Table 4.

Number of prognostic factors and anastomotic leak (n=380)

No. of prognostic factors	Anastomotic leak		P-value
No. of prognostic factors	No (n=373)	Yes (n=7)	P-value
0	77 (20.6)	4 (57.1)	0.132
1	106 (28.4)	3 (42.9)
2	101 (27.1)	0 (0)
>2	89 (23.9)	0 (0)

Table 5.

Logistic regression analyzed prognostic factors related to anastomotic leak (n=380)

Factor	Odds ratio	95% Confidence interval	P-value
Age (yr)	1.002	0.936–1.073	0.950
Sex	0.868	0.192–3.931	0.854
Body mass index (kg/m²)	NE	-	0.979
Smoking status	NE	-	0.956
Alcohol consumption	NE	-	0.980
ASA physical status	NE	-	0.645
Malnutrition (NRS ≥3)	NE	-	0.848
Diabetes	NE	-	0.959
Vascular disease	2.738	0.326–23.008	0.354
NSAID use	NE	-	0.996
Anticoagulant therapy	NE	-	0.963
Antiaggregant therapy	NE	-	0.957
Chemotherapy	NE	-	0.980
Immunotherapy	NE	-	0.995
Previous intestinal intervention	1.682	0.200–14.169	0.633
Surgical technique	NE	-	0.687
Laparoscopy vs. robotic	0.536	0.058–4.982
Open vs. robotic	0.344	0.030–3.936
Anastomosis technique	NE	-	0.998
Type of anastomosis	NE	-	0.998
No intraoperative complication	0.016	<0.001–0.291	0.005
Anastomosis bleeding	NE	-	0.989
Operation time (min)	1.003	0.991–1.015	0.613

NE, not estimable, ASA, American Society of Anesthesiologists; NRS, numeric rating scale; NSAID, non steroid anti-inflammatory drug.

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Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study

DOI: https://doi.org/10.3393/ac.2024.00899.0128

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Figure

Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study

Fig. 1. Application of Glubran 2 (GEM) to an ileocolic anastomosis with a dedicated nebulizer.

Fig. 2. Study flowchart.

Graphical abstract

Fig. 1.

Fig. 2.

Graphical abstract

Improved outcomes with cyanoacrylate glue for ileocolic anastomosis in right colectomy: a multicenter study

Characteristic	Value
Age (yr)	70±11
Sex
Male	203 (53.4)
Female	177 (46.6)
Body mass index (kg/m²)	26.6 ± 4.2
ASA physical status
I, II	169 (44.5)
III, IV	211 (55.5)
Smoking status
No	299 (78.7)
Yes	81 (21.3)
Alcohol and psychotropic abuse
No	357 (93.9)
Yes	23 (6.1)
Type II diabetes mellitus
No	310 (81.6)
Yes	70 (18.4)
Malnutrition (NRS ≥3)	2 (0.5)
Vascular disease
No	258 (67.9)
Yes	122 (32.1)
NSAID use
No	374 (98.4)
Yes	6 (1.6)
Antiaggregant therapy
No	302 (79.5)
Yes	78 (20.5)
Anticoagulant therapy
No	322 (84.7)
Yes	58 (15.3)
Chemotherapy
No	363 (95.5)
Yes	17 (4.5)
Previous intestinal surgery
No	296 (77.9)
Yes	84 (22.1)

Variable	Value
Surgical technique
Open	154 (40.5)
Laparoscopy	198 (52.1)
Robotic	27 (7.1)
Missing	1 (0.3)
Type of anastomosis
Side-to-side	293 (77.1)
End-to-side	81 (21.3)
End-to-end	5 (1.3)
Missing	1 (0.3)
Anastomosis technique
Mechanic	374 (98.4)
Stapler linear	286 (75.3)
Stapler circular	88 (23.2)
Handsewn	5 (1.3)
Missing	1 (0.3)
Abdominal drainage
No	128 (33.7)
Yes	251 (66.1)
Missing	1 (0.3)
Fecal diversion
No	371 (97.6)
Yes	8 (2.1)
Missing	1 (0.3)
Operation time (min)	148.8±59.6

Outcome	No. of patients (%)
Postoperative mortality	3 (0.8)
Clavien-Dindo classification
No complications	270 (71.1)
≤II	83 (21.8)
≥III	27 (7.1)
Anastomotic leak	7 (1.8)
Grade A	2/7 (28.6)
Grade C	5/7 (71.4)
Anastomotic bleeding	5 (1.3)
Infection	15 (3.9)
Intrabdominal fluid	11 (2.9)

No. of prognostic factors	Anastomotic leak		P-value
No. of prognostic factors	No (n=373)	Yes (n=7)	P-value
0	77 (20.6)	4 (57.1)	0.132
1	106 (28.4)	3 (42.9)
2	101 (27.1)	0 (0)
>2	89 (23.9)	0 (0)

Factor	Odds ratio	95% Confidence interval	P-value
Age (yr)	1.002	0.936–1.073	0.950
Sex	0.868	0.192–3.931	0.854
Body mass index (kg/m²)	NE	-	0.979
Smoking status	NE	-	0.956
Alcohol consumption	NE	-	0.980
ASA physical status	NE	-	0.645
Malnutrition (NRS ≥3)	NE	-	0.848
Diabetes	NE	-	0.959
Vascular disease	2.738	0.326–23.008	0.354
NSAID use	NE	-	0.996
Anticoagulant therapy	NE	-	0.963
Antiaggregant therapy	NE	-	0.957
Chemotherapy	NE	-	0.980
Immunotherapy	NE	-	0.995
Previous intestinal intervention	1.682	0.200–14.169	0.633
Surgical technique	NE	-	0.687
Laparoscopy vs. robotic	0.536	0.058–4.982
Open vs. robotic	0.344	0.030–3.936
Anastomosis technique	NE	-	0.998
Type of anastomosis	NE	-	0.998
No intraoperative complication	0.016	<0.001–0.291	0.005
Anastomosis bleeding	NE	-	0.989
Operation time (min)	1.003	0.991–1.015	0.613

Table 1. Demographic and clinical characteristics of the cohort (n=380)

Values are presented as mean±standard deviation or number (%).

ASA, American Society of Anesthesiologists; NRS, numeric rating scale; NSAID, nonsteroid anti-inflammatory drug.

Table 2. Surgical procedure data (n=380)

Values are presented as number (%) or standard deviation. Percentages may not total 100 due to rounding.

Table 3. Postoperative outcome and morbidity data (n=380)

Table 4. Number of prognostic factors and anastomotic leak (n=380)

Table 5. Logistic regression analyzed prognostic factors related to anastomotic leak (n=380)

NE, not estimable, ASA, American Society of Anesthesiologists; NRS, numeric rating scale; NSAID, non steroid anti-inflammatory drug.