Histoacryl®

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Histoacryl®

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Histoacryl®

The tissue adhesive Histoacryl® consists of monomeric n-butyl-2-cyanoacrylate, which polymerizes quickly in connection with tissue fluid.

Histoacryl® is available in two colors:

  • translucent, special for facial application
  • blue, which enables an easy control over the quantity applied in different indications approved.

Advantages

Skin closure 

  • Decreased skin closure time compared to sutures [1-8]
  • Microbial barrier action [9-12]
  • Less pain than suture materials is expected [2]
  • Only 30 seconds of holding the wound edges are needed [13]
  • Storage at room temperature <22 ºC [13]

Sclerotherapy

  • Indicated for bleeding esophagogastric varices and as a secondary prophylaxis in varices that have previously bled [14-39]
  • Final hemostasis is achieved in >90% of cases [14-16], [18], [20], [21], [24], [32], [34], [36-41
  • In gastric varices lower rebleeding rate than with band ligation is expected [17], [18], [20], [21], [27], [40-42]

Mesh fixation

  • Similar recurrence rate than with traditional fixation methods [43-51]
  • Stand-alone fixation method in different hernia repair techniques [43-47], [49-52]
  • Atraumatic method reported to be better tolerated by the patient than traditional fixation methods [43-49], [51], [52]
  • Low or similar intra- and postoperative morbidity compared to traditional fixation methods. [43], [45], [48], [49], [51]
  • Reduced risk of post-operative chronic pain compared to traditional fixation methods [43-49], [51]
  • Decreased surgery time compared to traditional fixation methods [45-48], [50]
  • Faster return to work compared to traditional fixation methods. [43], [45], [50], [53]
  • Lower or similar rate of infections related to Histoacryl than other techniques [43], [45-48], [54]
  • Only necessary to apply few small drops to the desired fixing sites. [55]
  • Can be used in laparoscopic and open hernia repair procedures. [46-53], [56-62]

Indication

  • Skin Closure: Closure of skin wounds without tension (including clean surgical incisions and incisions from minimally invasive surgery), and simple, thoroughly cleansed, trauma-induced lacerations.
  • Sclerotherapy: Sclerotherapy of large esophageal or fundal varices.
  • Mesh fixation: Fixation of hernia meshes, especially in inguinal hernia surgery.

Skin closure
[1] Elmasalme FN, Matbouli SA, Zuberi MS. Use of tissue adhesive in the closure of small incisions and lacerations. J Pediatr Surg. 1995;30(6):837–8. 
[2] Farion KJ, Russell KF, Osmond MH, Hartling L, Klassen TP, Durec T, et al.Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database Syst Rev. 2002;2002(3):CD003326. 
[3] Göktas N, Karcioglu O, Coskun F, Karaduman S, Menderes A. Comparison of tissue adhesive and suturing in the repair of lacerations in the emergency department. Eur J Emerg Med. 2002;9(2):155-8.
[4] Dumville JC, Coulthard P, Worthington HV, Riley P, Patel N, Darcey J, et al. Tissue adhesives for closure of surgical incisions. Cochrane Database Syst Rev. 2014;2014(11):CD004287. 
[5] Koonce SL, Eck DL, Shaddix KK, Perdikis G. A prospective randomized controlled trial comparing N-butyl-2 cyanoacrylate (Histoacryl), octyl cyanoacrylate (Dermabond), and subcuticular suture for closure of surgical incisions. Ann Plast Surg. 2015;74(1):107-10.
[6] Lloris-Carsí JM, Ballester-Álvaro J, Barrios C, Zaragozá-Fernández C, Gómez-De la Cruz C, González-Cuartero C, et al. Randomized clinical trial of a new cyanoacrylate flexible tissue adhesive (Adhflex) for repairing surgical wounds. Wound Repair Regen. 2016;24(3):568-80.
[7] Sun T, Liu S, Sun G. Application of Histoacryl Tissue Glue in Breast Surgery. IOP Conf Ser Mater Sci Eng 2019;562(1):012144.
[8] Witting S, Ingwersen M, Lehmann T, Aschenbach R, Eckardt N, Jürgen Zanow, et al. Wound Closure After Port Implantation-A Randomized Controlled Trial Comparing Tissue Adhesive and Intracutaneous Suturing. Dtsch Arztebl Int. 2021;118(44):749-55.
[9] Yulevich A, Cohen Z, Mares AJ. Use of N-Butyl-2-Cyanoacrylate (Histoacryl®) in Closure of Thoracoscopic an Laparoscopic Surgical Wounds in Children. Pediatric Endosurg. 1998;2(1):31-4. . 
[10] Ranson JM, Amin K, Schechter EM, Kosutic D. Haemostatic property of cyanoacrylate in pedicled flaps. Br J Oral Maxillofac Surg. 2016;54(9):1046-7.
[11] Gilardi E, Piano A, Chellini P, Fiori B, Dolcetti L, Pittiruti M, et al. Reduction of bacterial colonization at the exit site of peripherally inserted central catheters: A comparison between chlorhexidine-releasing sponge dressings and cyano-acrylate. J Vasc Access, 2021;22(4):597-601.
[12] Internal Report_MDT medical device testing GmbH report / Project 12m020 / Determination of Microbiological Barrier Properties of Two Topical Skin Adhesives
[13] Internal Report_RDR/DID/CHM/SLE/19078 – Real Time Stability Study on Histoacryl® –22 ºC

Sclerotherapy
[14] Lo GH, Lin CW, Perng DS, Chang CY, Lee CT, Hsu CY, et al. A retrospective comparative study of histoacryl injection and banding ligation in the treatment of acute type 1 gastric variceal hemorrhage. Scand J Gastroenterol. 2013;48(10):1198-204.
[15] Prachayakul V, Aswakul P, Chantarojanasiri T, Leelakusolvong S.  Factors influencing clinical outcomes of Histoacryl® glue injection-treated gastric variceal hemorrhage. World J Gastroenterol. 2013;19(15):2379-87.
[16] Kozieł S, Kobryń K, Paluszkiewicz R, Krawczyk M, Wróblewski T. Endoscopic treatment of gastric varices bleeding with the use of n-butyl-2 cyanoacrylate. Prz Gastroenterol. 2015;10(4):239-43.
[17] Holster IL, Tjwa ET, Moelker A, Wils A, Hansen BE, J. Reinoud Vermeijden, et al. Covered transjugular intrahepatic portosystemic shunt versus endoscopic therapy+ β‑blocker for prevention of variceal rebleeding. Hepatology. 2016;63(2):581-9.
[18] Yang J, Na YJ, Song YJ, Choi OH, Lee SK, Kim HG. The effectiveness of laparoendoscopic single-site surgery (LESS) compared with conventional laparoscopic surgery for ectopic pregnancy with hemoperitoneum. Taiwan J Obstet Gynecol. 2016;55(1):35-9.
[19] Jang WS, Shin HP, Lee JI, Joo KR, Cha JM, Jeon JW, et al. Proton pump inhibitor administration delays rebleeding after endoscopic gastric variceal obturation. World J Gastroenterol. 2014;20(45):17127-31.
[20] Kozieł S, Pawlak K, Błaszczyk Ł, Jagielski M, Wiechowska-Kozłowska A. Endoscopic Ultrasound-Guided Treatment of Gastric Varices Using Coils and Cyanoacrylate Glue Injections: Results after 1 Year of Experience. J Clin Med. 2019;8(11):1786.
[21] Chevallier O, Guillen K, Comby PO, Mouillot T, Falvo N, Bardou M, et al. Safety, efficacy, and outcomes of N-Butyl cyanoacrylate glue injection through the endoscopic or radiologic route for variceal gastrointestinal bleeding: a systematic review and meta-analysis. J Clin Med. 2021;10(11):2298
[22] Ayub M, Hussain S, Ahmed S. Histoacryl glue injection without lipiodol dilution and post sclerotherapy bleeding; prevalence among patients with upper GIT bleed. The Professional Med J. 2020;27(6):1182-6.
[23] Catron TD, Smallfield GB, Kang L, Sterling RK, Siddiqui MS. Endoscopic Cyanoacrylate Injection with Post-injection Audible Doppler Assessment of Gastric Varices: A Single-Institution Experience. Dig Dis Sci. 2017;62(11):3091-9.
[24] Tang RSY, Kyaw MH, Teoh AYB, Lui RNS, Tse Y-K, Lam TYT, et al. Endoscopic ultrasound guided cyanoacrylate injection to prevent rebleeding in hepatocellular carcinoma patients with variceal hemorrhage. J Gastroenterol Hepatol. 2020;35(12):2192-201.
[25] Lee HA, Goh HG, Kim TH, Lee Y-S, Suh SJ, Jung YK, et al. Evaluation of treatment response after endoscopic variceal obturation with abdominal computed tomography. Gut Liver. 2020;14(1):117-24.
[26] Stein DJ, Salinas C, Sabri S, Onyeali R, Caldwell S, Henry Z. Balloon retrograde transvenous obliteration versus endoscopic cyanoacrylate in bleeding gastric varices: comparison of rebleeding and mortality with extended follow-up. J Vasc Interv Radiol. 2019;30(2):187-94.
[27] Naga M, Wahba M, Okasha H, Farag A, El-Mazny A, Elbadri A, et al.  Comparative study of tissue adhesive therapy versus band ligation in control of actively bleeding esophageal varices. Acta Gastroenterol Belg. 2020;83(1):5-10.
[28] Korsic S, Stabuc B, Skok P, Popovic P. TIPS. endoscopic treatment for prevention of recurrent variceal bleeding: a long-term follow-up of 126 patients. Radiol Oncol. 2021;55(2):164-71.
[29] Lee HA, Chang JM, Goh HG, Kim TH, Lee Y-S, Suh SJ, et al. Prognosis of patients with gastric variceal bleeding after endoscopic variceal obturation according to the type of varices. Eur J Gastroenterol Hepatol. 2019;31(2):211–7. 
[30] Lôbo MRA, Chaves DM, DE Moura DTH, Ribeiro IB, Ikari E, DE Moura EGH. Safety and efficacy of EUS-guided coil plus cyanoacrylate versus conventional cyanoacrylate technique in the treatment of gastric varices: a randomized controlled trial. Arq Gastroenterol. 2019;56(1):99-105.
[31] Schultheiß M, Giesler M, Maruschke L, Schmidt A, Sturm L, Thimme R, et al. Adjuvant transjugular variceal occlusion at creation of a transjugular intrahepatic portosystemic shunt (TIPS): efficacy and risks of bucrylate embolization. Cardiovasc Intervent Radiol. 2019;42(5):729-36.
[32] Nasir MB, Mushtaq J, Amjad I, Tayyab GU, Haq IU, Rasool S, et al. Histoacryl® (N-butyl-2-cyanoacrylate) injection mixed with olive oil for endoscopic treatment of gastric varices – an equally safe alternative. J. Fatima Jinnah Med Univ. 2018;12(3):102-5.
[33] Lo G-H, Lin C-W, Tai C-M, Perng D-S, Chen I-L, Yeh J-H, et al. A prospective, randomized trial of thrombin versus cyanoacrylate injection in the control of acute gastric variceal hemorrhage. Endoscopy. 2020;52(7):548-55. 
[34] Choe JW, Yim HJ, Lee SH, Chung HH, Lee YS, Kim SY, et al. Primary prophylaxis of gastric variceal bleeding: endoscopic obturation, radiologic intervention, or observation? Hepatol Int. 2021;15(4):934-45.
[35] Jesrani A, Awan RH, Memon LA, Nayab S. Outcome of patients treated with N-Butyl-2-cyanoacrylate in gastric variceal bleeding. Prof Med J. 2021;28(10):1463–9. 
[36] Carlin Ronquillo A, Bravo Paredes EA, Espinoza-Rios JL, Aguilar Sanchez V, Zegarra Chang A, García Encinas CA, et al. [Use of cyanoacrylate as a treatment of gastric varices in a public hospital in Lima - Peru]. Rev Gastroenterol Peru. 2019;39(3):246-51. 
[37] Liu Y, Yang Y, Sun G, Chai G, Wang J, Jiang H, et al. The effects of emergent endoscopic variceal sclerotherapy combined with acrylate glue injection on esophageal variceal bleeding. Biomedical Research, 2017;28(1):238-42. 
[38] Li H, Ye D, Li P, Kong D. Endoscopic clipping prior to GVO vs. GVO in IGV1 bleeding: a multicenter retrospective clinical trial. Endosc Int Open. 2019;7(11):E1365-E1370.
[39] Kamani L, Ahmad BS, Arshad M, Ashraf P. Safety of endoscopic N-Butyl-2 Cyanoacrylate injection for the treatment of bleeding gastric varices in children. Pak J Med Sci. 2018;34(6):1363-8.
[40] Cho E, Jun CH, Cho SB, Park CH, Kim HS, Choi SK, et al. Endoscopic variceal ligation-induced ulcer bleeding: What are the risk factors and treatment strategies? Medicine (Baltimore). 2017;96(24):e7157. 
[41] Faheem M, Khurram M, Ambreen S, Arif M, Amjad W, Iqbal R, et al. Band ligation versus glue injection for bleeding gastric varices. J Rawal Med Coll, 2017;21(4):317-20.
[42] Tan P-C, Hou M-C, Lin H-C, Liu T-T, Lee F-Y, Chang F-Y, et al. A randomized trial of endoscopic treatment of acute gastric variceal hemorrhage: N butyl 2 cyanoacrylate injection versus band ligation. Hepatology. 2006;43(4):690-7.

Mesh fixation
[43] Helbling C, Schlumpf R. Sutureless Lichtenstein: first results of a prospective randomised clinical trial. Hernia. 2003;7(2):80-4. 
[44] Testini M, Lissidini G, Poli E, Gurrado A, Lardo D, Piccinni G. A single-surgeon randomized trial comparing sutures, N-butyl-2-cyanoacrylate and human fibrin glue for mesh fixation during primary inguinal hernia repair. Can J Surg. 2010;53(3):155-60.
[45] Kim-Fuchs C, Angst E, Vorburger S, Helbling C, Candinas D, Schlumpf R. Prospective randomized trial comparing sutured with sutureless mesh fixation for Lichtenstein hernia repair: long-term results. Hernia. 2012;16(1):21-7.
[46] Hoyuela C, Juvany M, Carvajal F, Veres A, Troyano D, Trias M, et al. Randomized clinical trial of mesh fixation with glue or sutures for Lichtenstein hernia repair. Br J Surg. 2017;104(6):688-94.
[47] Vega L, Oh-Uiginn K, Carmona D, Salazar D, Rodriguez R, Janafse H, et al. Cyanoacrylate mesh fixation in Lichtenstein inguinal hernia repair. Does it have advantages? Glob J Surg. 2019;7(1):1–4 
[48] Shukla A, Mathur RK, Sheikh Z, Jain V. N-Butyl-2-Cyanoacrylate Glue versus Suture for Mesh Fixation in Open Inguinal Hernioplasty. J Evol Med Dent Sci. 2019;8(48):3575–8. 
[49] Mathur DRK, Baghel DH, Pancholi DA. To evaluate the efficacy of N-butyl cyanoacrylate glue for mesh fixation in laparoscopic inguinal hernia repair. Int J Surg Sci. 2020;4(1):197–9.
[50] Juvany M, Guillaumes S, Hoyuela C, Bachero I, Trias M, Ardid J, et al. Results of a Prospective Cohort Study on Open Rives Technique of the Midline Incisional Hernia: Midline Closure and Mesh Overlap. Surg Innov. 2022;29(3):321–8.
[51] Yu CC, Chen YT, Huang CS, Chueh SJ, Lo CW, Tsai YC. A comprehensive study comparing tack and glue mesh fixation in laparoscopic total extraperitoneal repair for adult groin hernias. Surg Endosc. 2020;34(10):4486-93.
[52] Liew W, Wai YY, Kosai NR, Gendeh HS. Tackers versus glue mesh fixation: an objective assessment of postoperative acute and chronic pain using inflammatory markers. Hernia. 2017;21(4):549-54.
[53] Raafat A, Osman G. Histoacryl Glue versus Polypropylene Suture Mesh Fixation in Lichtenstein Inguinal Hernioplasty. Int. J. of Life Sciences, 2018;6(1):1-5.
[54] Kukleta JF, Freytag C, Weber M. Efficiency and safety of mesh fixation in laparoscopic inguinal hernia repair using n-butyl cyanoacrylate: long-term biocompatibility in over 1,300 mesh fixations. Hernia. 2012;16(2):153-62.
[55] Internal Report_RDR/DID/CHM/SLE/21182 - Determination of Adhesive Strength – Mesh Fixation with Histoacryl 
[56] Habeeb TAAM, Mokhtar MM, Sieda B, Osman G, Ibrahim A, Metwalli A-EM, et al. Changing the innate consensus about mesh fixation in trans-abdominal preperitoneal laparoscopic inguinal hernioplasty in adults: Short and long term outcome. Randomized controlled clinical trial. Int J Surg. 2020;83:117–24. 
[57] Matikainen M, Aro E, Vironen J, Kössi J, Hulmi T, Silvasti S, et al. Factors predicting chronic pain after open inguinal hernia repair: a regression analysis of randomized trial comparing three different meshes with three fixation methods (FinnMesh Study). Hernia. 2018;22(5):813–8.
[58] Hoyuela C, Juvany M, Trias M, Ardid J, Martrat A. Incisional hernia prevention using a cyanoacrilate-fixed retrofascial mesh. Prevención de la hernia incisional mediante malla retrofascial fijada con cianoacrilato. Cir Esp (Engl Ed). 2018;96(1):35-40.
[59] Atlam KM, Moussa RH, Mlees AM, Elnemr AA. Evaluation of cyanoacrylate glue in mesh fixation in non-incisional ventral hernia. Med J Cairo Univ. 2019;87(September):3219–26.
[60] Matikainen M, Vironen J, Kössi J, Hulmi T, Hertsi M, Rantanen T, et al. Impact of mesh and fixation on chronic inguinal pain in Lichtenstein hernia repair: 5‐year outcomes from the Finn mesh study. World J Surg. 2021;45(2):459–64.
[61] Mateska TG, Kunst g, Cerni I, Pecovnik J, Omejc M. A comparison study of the efficacy of tacker mesh fixation, glue mesh fixation and no mesh fixation in transabdominal preperitoneal inguinal hernia repair. Coll Antropol. 2018;42(4):271-6. 
[62] Fouda E, Thabet W, Elsaid M, Emile SH, Elbaz SA. A randomized clinical trial of mesh fixation with cyanoacrylate glue compared to sutures in inguinal hernia repair. Int J Abdom Wall Hernia Surg. 2020;3:56-62