***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background : Excluding pulmonary embolism , anastomotic leak is the leading cause of death and major morbidity in patients undergoing open or laparoscopic gastric bypass operations . We observed a number of these leaks ( 11 out of 1,120 MicropouchSM gastric bypass [ MGB ] patients ; 0.9 % ) . The majority ( 80 % ) required emergency laparotomy and drainage , massive fluid resuscitation , and aggressive nutritional support . Therefore , we design ed a 2-year , prospect i ve study to determine the therapeutic efficacy of vapor-heated fibrin sealant to prevent anastomotic leaks at the gastro-jejunostomy ( GJS ) site . Methods : Between April , 2000 and March , 2002 , 738 patients underwent a primary ( n=671 ) or revisionary ( n=67 ) MGB procedure . The gastric reservoir was limited to the cardia of the stomach . Vapor-heated fibrin glue 1 cc was applied circumferentially to a 12-mm , non-b and ed GJS anastomosis . Once activated , fibrin sealant polymerized into a soft , closely adherent gel . No omental patch was used to cover the fibrin-sealed anastomosis . Results : Of 738 patients , 2 required emergency laparotomy for leaks and 2 for adhesive b and s that contributed to a distal small bowel obstruction . There were no anastomotic leaks at the fibrin-sealed GJS sites . No gastro-gastric or gastro-enteric fistulas were recorded . Conclusion . Fibrin sealant applied to the GJS site appears to have eliminated anastomotic leaks in our MicropouchSM gastric bypass patients . These results suggest that fibrin glue application may contribute to " leak prophylaxis " in patients undergoing open Rouxen-Y gastric bypass . Glue placements may also benefit patients undergoing a laparoscopic Roux-en-Y procedure , wherein anastomotic leaks have been reported early in the learning curve PURPOSE : The aim of this study was to investigate the role of omentoplasty , by means of intact omentum , in preventing anastomotic leakages after rectal resection . METHODS : Between 1992 and 1997 a total of 112 patients ( 64 males ) with a mean age of 64.7 ( range , 39–83 ) years were r and omly assigned to undergo omentoplasty ( Group A ) or not ( Group B ) to reinforce the colorectal anastomosis after anterior resection for rectal cancer . The primary end point was anastomotic leakage ; the secondary end point included morbility and mortality related to omentoplasty . RESULTS : The two groups were comparable in terms of preoperative and intraoperative characteristics . Staple-ring disruption at plain abdominal radiographs was detected in seven instances in Group A and in ten in Group B patients ( P = not significant ) . Two leakages were evident clinical ly in Group A and seven in Group B ( P<0.05 ) . Three leaks were documented radiologically in Group A and eight in Group B ( P = not significant ) . No complications related to omentoplasty were observed in Group A. There were two repeat operations for anastomotic leakage in Group B. At follow-up , one stricture developed in Group A and three in Group B ( P = not significant ) CONCLUSIONS : Despite a similar incidence of staple-ring defects , a strikingly lower rate of clinical ly and radiologically detected leaks developed in patients su bmi tted to omentoplasty .  Although not affecting the incidence of anastomotic disruption , omentoplasty seems to contain the severity of anastomotic leakage BACKGROUND Despite improved surgical techniques , anastomotic leakage remains as a serious complication in colorectal surgery , producing increased morbidity and mortality . This prospect i ve study was initiated to test the hypothesis that preexisting disorders in the extracellular matrix ( ECM ) may be a factor influencing the onset of anastomotic wound healing complications . METHODS In this prospect i ve study of 119 patients with colorectal anastomoses  , 30 clinical parameters with possible influence on anastomotic complications were evaluated . From all patients , sample s of macroscopically intact colonic tissue were obtained at the index operation . Crosspolarization microscopy was performed to analyze the collagen type I/III ratio , and immunohistochemical studies were done to determine the expression of matrix metalloproteinase ( MMP ) 1 , 2 , 9 , and 13 . The patients with uncomplicated postoperative healing were compared with those developing anastomotic leakage . RESULTS Patients with impaired anastomotic healing exhibited a significantly lower collagen type I/III ratio compared with the controls . Significantly higher expression of MMP-1 and MMP-2 in the mucosal layers and of MMP-2 and MMP-9 in the submucosal layers was found in the normal bowel wall of the leakage group . These findings were statistically independent from the clinical parameters . CONCLUSION The present study confirms the hypothesis that disturbances of the ECM play a role in the pathogenesis of anastomotic leakage after large bowel surgery A left-sided colon obstruction was produced with a polypropylene sling  in 65 rats . Colon resection and primary anastomosis were performed three days later . The animals were then r and omly allocated to the FG ( fibrin glue ) group receiving sealing of the anastomosis with 0.4 ml of fibrin glue ( Beriplast R ) , or to the NG ( non-glue ) group . The anastomoses were assessed 30 min , two days and four days later . Adhesion formation was similar in both groups . The number of macroscopic or radiological leakages did not differ either . At 30 min the mean bursting pressure was 74.6 + /- 8.6 ( SD ) mmHg in the FG group and 58.3 + /- 21.6 mmHg in NG ( non-glue ) group ( p less than 0.05 , Mann-Whitney test ) . Later on the strength of the anastomoses was equal in both groups . We conclude that the initial sealing of weak points in the anastomoses was beneficial but the inherent strength per se could not be enhanced Purpose To investigate whether a collagen fleece kept in place by fibrin glue might seal off a colorectal anastomosis , provide reinforcement , and subsequently improve anastomotic healing . Methods Wistar rats underwent a 1-cm left-sided colonic resection followed by a 4-suture end-to-end anastomosis .  They were then r and omly assigned to one of three treatment groups : no additional intervention ( control , n = 20 ) , the anastomosis covered with fibrin glue ( fibrin glue , n = 20 ) , the anastomosis covered with a collagen fleece , kept in place with fibrin glue ( collagen fleece , n = 21 ) . At either 3 or 7 days follow-up , anastomotic bursting pressure was measured and tissue was obtained for histology and collagen content assessment after which animals were sacrificed . Results Three rats in the control ( 15 % ) , three in the fibrin glue ( 15 % ) , and one in the collagen group ( 4.8 % ) died due to anastomotic complications ( P = 0.497 ) . Anastomotic bursting pressures were not significantly different between groups at 3 and 7 days follow-up ( P = 0.659 and P = 0.427 , respectively ) . However , bowel obstructions occurred significantly more often in the collagen group compared to the control group ( 14/21 vs. 3/20 , P = 0.003 ) . Collagen contents were not different between groups , but histology showed a more severe inflammation in the collagen group compared to the other groups at both 3 and 7 days follow-up . Conclusions A collagen fleece kept in place by fibrin glue does not improve healing of colonic anastomoses in rats . Moreover , this technique induces significantly more bowel obstructions in rats , warranting further study before being translated to a clinical setting Objective The aim of this study was to characterize a successful approach for the management of infants with long-gap esophageal atresia ( EA ) with tracheoesophageal fistula ( TEF ) . The goal was to preserve the native esophagus and minimize the incidence of esophageal anastomotic leaks using fibrin glue as a sealant over the esophageal anastomosis . Method A total of 52 patients were evaluated in this study . Only patients in whom , gap between the two ends of the esophagus was ≥ 2 cm were selected during January 2005 to January 2007 . Patients were divided in two groups on the basis of block r and omization . Group A comprised the patients in whom fibrin sealant was used as reinforcement on a primary end-to-end esophageal anastomosis ; in group B , fibrin glue was not used . The two groups were compared in terms of esophageal anastomotic leak ( EL ) , postoperative esophageal stricture ( ES ) , and mortality . The statistical analysis was done using Fisher ’s exact test and the chi-squared test . Result The number of anastomotic leaks in group A ( glue group ) was about one-fifth that in group B ( no glue group ) . The incidence of ES was almost twice as high in group B as in group A. The mortality rate was almost threefold higher in group B ( no-glue group ) . The higher incidence of EL and ES in group B compared to group A was statistically significant . Conclusion Thus , fibrin glue when used as an adjunct to esophageal anastomosis for primary repair of long-gap EA with TEF appears safe in the clinical setting and may lower the chances of esophageal leak and anastomosis-site strictures . Hence , it can diminish the mortality and morbidity of these patients Abstract Background After colon resection for colonic cancer , the administration of antineoplastic agents may prolong survival by killing residual cancer calls and preventing metastasis , but may also slow anastomotic healing . This study was design ed to determine the effects of 5-fluorouracil ( 5-FU ) and leucovorin ( LEV ) , injected intraperitoneally , on the healing of colonic anastomoses with or without fibrin glue ( FG ) covering . Methods Sixty rats were r and omized to one of four groups . After resection of a transverse colon segment , an end-to-end sutured anastomosis was performed . Rats in the 5-FU+LEV and the 5- FU+LEV+FG groups received 5-FU+LEV intraperitoneally . The colonic anastomoses of the rats in the FG group and in the 5-FU+LEV+FG group were covered with fibrin glue . All rats were killed on postoperative day 8 . Bursting pressure measurements were recorded and the anastomoses were examined macroscopically and histologically . Results The leakage rate of the anastomoses was significantly different among groups . Specifically , the leakage rate was significantly higher in the 5-FU+LEV group ( 40 % ) than in the FG and in the 5-FU+LEV+FG groups where there were no leakages ( p=0.017 ) . The mean adhesion formation score was significantly higher in rats of the 5-FU+LEV group , compared to the control ( p=0.023 ) , the FG ( p=0.006 ) and the 5-FU+LEV+FG ( p=0.006 ) groups . Bursting pressures were significantly lower in the 5-FU+LEV group than in the other groups ( p<0.001 ) . Also , bursting pressures were significantly lower in the control group compared to the FG and 5-FU+LEV+FG groups ( p<0.001 ) . Rats in the 5-FU+LEV+FG group had significantly greater neoangiogenesis and fibroblast activity than those in the 5-FU+LEV group ( p=0.025 ) . Conclusion The early intraperitoneal postoperative administration of 5-fluorouracil plus leucovorin impaired colonic wound healing . However , the application of fibrin glue prevented the deleterious effect of chemotherapy OBJECTIVE To investigate the role of omentoplasty ( OP ) in the prevention of anastomotic leakage after colonic or rectal resection . SUMMARY BACKGROUND DATA It has been proposed that OP -- wrapping the omentum around the colonic or rectal anastomosis -- reinforces intestinal sutures with the expectation of lowering the rate of anastomotic leakage . However , there are no prospect i ve , r and omized trials to date to prove this . METHODS Between September 1989 and March 1994 , a total of 705 patients ( 347 males and 358 females ) with a mean age of 66 + /- 15 years ( range , 15 - 101 ) originating from 20 centers were r and omized to undergo either  OP ( n = 341 ) or not ( NO , n = 364 ) to reinforce the colonic anastomosis after colectomy . Patients had carcinoma , benign tumor , colonic Crohn 's disease , diverticular disease of the sigmoid colon , or another affliction located anywhere from the right colon to and including the midrectum . Patients undergoing emergency surgery were not included . R and om allotment took place once the resection and anastomosis had been performed 
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Conclusion : In the available studies , FG did not consistently have a positive influence on the healing of gastrointestinal anastomoses .
It is consequently plausible that the positive effect of FG sealing of gastrointestinal anastomoses , if there is any , may be due to a mechanical sealing effect rather than due to improved healing per se