The development of surgical adhesives in the mid-20th century brought about a new alternative to mechanical methods of wound fixation and closure, such as sutures and staples. The purpose of this new tissue adhesion method was to provide effective hemostasis and fixation between two tissues or between an implanted device and a tissue, while still reducing tissue trauma and speeding up the healing and recovery time of patients undergoing surgery. We now know the ideal properties of a surgical glue.1:
Cyanoacrylate glues first appeared in the 1950s. They are now well known in the medical field and used in surgery, as their hydrophilic properties ensure proper diffusion in human tissue, they generate little heat during polymerization, which prevents tissue necrosis after application, they have good mechanical properties, including elasticity, and they are well tolerated, with low-toxicity degradation products, which are metabolized by the body. 1
In July 2022, NICE produced a study document on the benefits of using cyanoacrylate surgical glue to fixate reinforcement implants when treating hernias, as an alternative to mechanical fixation methods or fibrin glue. They brought together clinical data from 15 randomised clinical trials evaluating the efficacy and safety of cyanoacrylate glue in hernia repair procedures on a total of 1,374 patients. The results showed that cyanoacrylate glue was just as effective as comparative fixation methods (sutures, fibrin glue).
Experts have indicated that one of the innovative aspects of using cyanoacrylate glue in hernia surgery would be to limit post-operative traumatic complications and in particular the chronic pain associated with implant fixation. Using cyanoacrylate glue would also reduce the risk of hernia relapse, the length and cost of hospital stays and would enable patients to return earlier to work and normal activities. 2 These recommendations support the use of cyanoacrylate glue as an alternative to other traditional methods to fixate reinforcement implants in hernia repair procedures.
Compared with the article: read the full NICE document – Medtech innovation briefing- Cyanoacrylate glue for hernia mesh fixation – 5 July 2022 by clicking on this link here.
The new NICE guidelines pave the way for wider use of cyanoacrylate glue in surgical procedures. Its value in a variety of procedures has been the subject of several clinical studies in gastrointestinal, visceral and urogynaecological surgery, some of which are listed in the table below. Cyanoacrylate glue has also been described as a tissue adhesive for closing lesions in ophthalmology and neurosurgery, and for reinforcing suture lines in vascular surgery (studies not cited here). 1
In all of these studies, the efficacy of fixation and hemostasis achieved with cyanoacrylate glue was comparable to other types of fixation, and potential improvements were noted in comfort during the operation for the practitioner and post-surgical comfort for the patient, with less pain associated with the procedure and a quicker return to their usual activities. 3.4
The use of cyanoacrylate glue in your gastrointestinal, visceral and urogynaecological surgical procedures for fixation and hemostasis will provide you with a safe and effective alternative to traditional fixation and hemostasis methods with numerous benefits:
Benefits for your surgical teams: 1.3
Benefits for your patients: 1,3
Key words: Surgical glue, cyanoacrylate glue, implant fixation, breach closure, staple line reinforcement, suture line reinforcement, bariatric surgery, visceral surgery