Application of Surgical Adhesive Reduces Ureteroureterostomy Leakage

Their close proximity to abdominal structures and organs places the ureters at risk of iatrogenic injury during abdominal and pelvic surgical procedures. Ureteroureterostomy is the mainstay intervention for the repair of the proximal and middle ureter. However, the anastomosis may be subject to leakage, leading to potentially serious complications, including urinary tract infection, peritonitis, sepsis, and kidney damage. This study addressed the hypothesis that topical application of surgical adhesive reduces acute anastomotic leakage without increasing ureteric resistance. Nine ureters from domestic swine were pump-perfused with 0.9% sodium chloride (NaCl) at approximately 5, 10, 12, 15, and 20 mmHg (2 min/step), while flow and ureteral resistance were monitored, under three conditions: pre-transection, following ureteroureteral anastomosis with suture, and after topical application of Dermabond® surgical adhesive around the anastomosis circumference. Leakage was taken as the loss of fluid volume between the perfusate reservoir and the post-ureter receptacle. Values were compared by two-factor repeated measures ANOVA combined with the post hoc Tukey test. Leakage from the perfused ureter increased severalfold following transection and surgical anastomosis vs. pre-transection at all five perfusion pressures. Application of surgical adhesive to the anastomosis returned leakage to the pre-transection rate across the entire perfusion pressure range. There were no significant differences in ureteral flows and resistances among the three conditions. Thus, the application of surgical adhesive to the ureteroureteral anastomosis effectively prevented ureteric leakage at physiologic luminal pressures without increasing ureteral flow resistance.