Context
Leak from an intestinal anastomosis is the complication most feared by colorectal surgeons. The role of omentoplasty in securing colorectal anastomoses is controversial. Collagen-bound fibrin sealant sheets have recently been used in many aspects of surgery and many experimental animal studies have proven its efficacy in securing gastrointestinal anastomoses. The safety and feasibility of a collagen-bound fibrin sealant has been proven. Its application in sealing colonic anastomosis is a new field and needs to be evaluated.
Aim
The aim of this study was to evaluate and compare the efficacy of omentoplasty versus TachoSil in decreasing the rate of anastomotic leakage in colorectal anastomoses.
Settings and design
This is a prospective randomized trial.
Materials and methods
Ninety-seven patients with colonic anastomosis were divided into two groups; 48 were subjected to omentoplasty and 49 to TachoSil for prevention of leakage. The patients were followed up for symptoms and signs of leakage postoperatively.
Statistical analysis
Continuous variables were expressed as means and SD. Categorical variables were expressed as frequencies and percentage.
Results
The rate of clinical leakage in the omentoplasty group was 8.3% and that in the TachoSil group was 2%, which was within the reported range of 1.5–16%. Three out of four leakages in the omentoplasty group were severe (>500 ml/day) and the only case in the TachoSil group was less severe (<500 ml/day). The average hospital stay in the omentoplasty group was 9.3 days and that in the TachoSil group was 7.2 days (<0.05).
Conclusion
The study proved that TachoSil is more effective than omentoplasty in preventing anastomotic leakage. The use of the collagen-bound fibrin sealant TachoSil appears to be beneficial, being better than omentoplasty with respect to the length of hospital stay and severity of leakage, if leakage is inevitable.