The use of a novel adhesive tissue patch as an aid to anastomotic healing.

Introduction One of the most feared complications of colorectal surgery is anastomotic leak. Numerous techniques have been studied in the hope of decreasing leakage. This study was designed to assess the handling characteristics of a novel adhesive tissue patch (TissuePatch™; Tissuemed, Leeds, UK) applied to colorectal anastomoses in a pilot study. This was with a view to assessing its potential role in aiding anastomotic healing in subsequent trials. Methods A patch was applied to colorectal anastomoses after the surgeon had completed the anastomosis and prior to abdominal closure. Handling characteristics and patient outcomes were recorded prospectively. Results Nine patients were recruited before the study was prematurely terminated. In one patient, the patch fell off and in another patient, the surgeon omitted to apply it. Six patients had significant postoperative problems (1 confirmed leak necessitating return to theatre and excision anastomosis, 3 suspicious of leak on computed tomography delaying discharge, 2 perianastomotic collections). One patient had an uneventful recovery. Conclusions Although the handling characteristics of this novel tissue patch were deemed satisfactory, it appears that wrapping a colorectal anastomosis with an adhesive hydrophilic patch has significant deleterious effects on anastomotic healing. This could be a consequence of the creation of a microenvironment between the patch and the anastomosis that impairs healing. Further research is required to better understand the mechanisms involved. At present, the use of such patches on colorectal anastomoses should be discouraged outside the confines of a well monitored trial.

Folate intake in young women and their knowledge of preconceptional folate supplementation to prevent neural tube defects.

OBJECTIVES: To ascertain knowledge of periconceptional folate for prevention of neural tube defect (NTD) and to estimate folate intake in young women. STUDY DESIGN: Three hundred young women were questioned about their knowledge of folate for prevention of NTD. Their folate intake was assessed by food frequency questionnaire. RESULTS: Fourteen per cent of 16-19 year olds and 41% of undergraduates were aware of the need to increase folate intake before conception. Median folate intake was estimated to be 235 micrograms/d in 16-19 year olds and 248.5 micrograms/d in undergraduates. More than a quarter of women in both groups had folate intakes less than the reference nutrient intake (RNI) (200 micrograms/d) below which prevalence of NTD rises dramatically and these women would therefore be at increased risk of having a child with NTD should they have an unplanned pregnancy. CONCLUSIONS: Strategies are required to increase folate intake among young women and inform them of the benefit of peri-conceptional folate supplementation.