Tissue Sealants & Adhesives
Agents applied to seal tissue interfaces, reinforce anastomoses, close tunical or serosal defects, or approximate skin — functioning as either sealants (fibrin-based, hemostatic + barrier function) or adhesives (cyanoacrylate, PEG-based, primarily mechanical approximation).
These agents occupy a distinct niche from hemostatic matrices (which control active bleeding) and from biomaterials implants (which provide long-term structural function). Sealants bridge the two — they set quickly, serve a mechanical role for days to weeks, and resorb without long-term foreign-body presence.
Agent Library
- Fibrin Sealants (Tisseel, Evicel, Artiss)Dual-component fibrinogen + thrombin delivered as a spray or drip; mimics the final common pathway of coagulation to form fibrin at the application site. The workhorse tissue sealant in GU reconstruction — urinary diversion, pyeloplasty, anastomotic reinforcement, Peyronie's grafting, pelvic dead-space obliteration.
- TachoSil / Evarrest (Collagen-Fibrinogen Patches)Solid-phase fibrin sealant delivered as a pre-formed patch — fibrinogen + thrombin bonded to a collagen sponge carrier. Self-adherent on bleeding surfaces. Workhorse in Peyronie's PICS technique, partial nephrectomy collecting system repair, and urinary diversion anastomotic reinforcement.
- Cyanoacrylates (Dermabond, Histoacryl)Liquid monomer adhesives that polymerize on contact with tissue moisture. Primary role in skin closure — topical layer over subcuticular suture; not used within the abdomen or on mucosal surfaces.
- PEG-Based Sealants (CoSeal)Synthetic polyethylene-glycol-based sealants; two-component sprayed hydrogel that cures within seconds. Used for pneumostasis, dural sealing, and — in selected urologic applications — reinforcement of urinary-tract suture lines.
Mechanism Class Comparison
| Agent class | Core mechanism | Cure time | Duration in body |
|---|---|---|---|
| Fibrin sealants | Fibrinogen + thrombin → fibrin clot | ~10 seconds | 10–14 days (resorbs) |
| Collagen-fibrinogen patches | Fibrin sealant bonded to collagen carrier | ~3 minutes contact | 3–6 months (collagen resorbs) |
| Cyanoacrylates | Moisture-activated polymerization | ~30 seconds | Sloughs off skin over 5–10 days |
| PEG sealants | Two-component PEG crosslinking | Seconds | 30 days (hydrolysis) |
Selection by Clinical Situation
| Need | First-line |
|---|---|
| Urinary diversion anastomosis reinforcement | Fibrin sealant sprayed over the closure |
| Peyronie's tunical defect after plaque excision/incision | TachoSil collagen fleece |
| Partial nephrectomy collecting-system repair reinforcement | TachoSil or fibrin sealant |
| Urethroplasty anastomosis reinforcement | Fibrin sealant |
| Pelvic dead-space obliteration (exenteration, APR) | Fibrin sealant + omental flap |
| IPP + grafting over cylinders (PICS technique) | TachoSil |
| Skin closure as top layer | Dermabond (2-octyl cyanoacrylate) |
| Ureteral or bladder suture line reinforcement | Fibrin sealant or PEG sealant |
| Graft-to-tunica inosculation (BMG ureteroplasty) | Fibrin sealant (thin film under the graft) |