The Effect of TISSEEL® on the Healing Process of Uterine Horn Reanastomosis in an Experimental Animal Model.

Background and Objectives: Tubal reanastomosis is an alternative option for women seeking fertility after sterilization. Thus, anastomosis healing quality and peri-tubal adhesions play a crucial role. TISSEEL® fibrin sealant may enhance tissue repair and reduce foreign-body reaction. We evaluated the effect of TISSEEL®, used alone or with sutures, on anastomotic healing and adhesion formation in a rat uterine horn model. Materials and Methods: Thirty female Wistar rats were randomized to Suture, TISSEEL®, or Suture + TISSEEL® groups (n = 10 each). After bilateral uterine horn transection, reanastomosis was performed with sutures alone, fibrin sealant alone, or combined sutures and sealant. On postoperative day 14, reanastomosis segments were collected for blinded histologic assessment and evaluation of modified Ehrlich-Hunt score parameters (inflammation, fibrosis, neovascularization and collagen production). Intra-abdominal adhesions were also macroscopically assessed. Results: Two animals died perioperatively and 56 uterine horns were included in the final analysis (Suture n = 18, TISSEEL®n = 18, Suture + TISSEEL®n = 20). The distribution of inflammation and fibrosis severity grades, as assessed by the modified Ehrlich-Hunt scoring system, did not differ significantly between the study groups (p = 0.208 and p = 0.652, respectively). In contrast, high-grade neovascularization (grades 3-4) was more common in TISSEEL® groups (77.8% TISSEEL®, 80.0% Suture + TISSEEL®, 33.3% Suture, p = 0.004), while increased collagen deposition was also more common in the TISSEEL® groups (p = 0.011), after binary analysis. Severe adhesions were more common in the Suture group (66.7% vs. 11.1% in the TISSEEL® group and 30.0% in the Suture + TISSEEL® group, p = 0.037). Conclusions: TISSEEL®, alone or as an adjunct to sutures, improves neovascularization and collagen production and is associated with milder adhesions without increased inflammation or fibrosis. The use of fibrin sealant TISSEEL® may be a useful tool in tubal reconstructive surgery.