ABSTRACT
AIM:
Pancreatic fistula (PF) represents the main complication (10%-29%) after pancreatic surgery. Soft pancreatic texture with a not dilated pancreatic duct represent the major risk factors for PF. Mortality after pancreaticoduodenectomy (PD) is reported in several large series to be <5%. PF and local sepsis are the main causes of delayed arterial hemorrage with a high mortality rate (14-38%). Therefore, any effort should be implemented in order to reduce the incidence of PF.
METHODS:
In the present study we have extended the use of the biological adhesive Bioglue® to coat pancreatic resection surface after distal pancreasectomy (DP, N.=5) and pancreatico-jejunostomy (PJ) after PD (N.=18).
RESULTS:
Operative mortality was observed in 2 instances: one case after PJ leakage (1/18, 5.5%) and one case after DP not related to PF (1/5, 20%). PF has been documented in 7/23 (30,4%) after pancreatic resection, and in all cases after PD. In 3 cases PF has been successfully treated conservatively by NPO and octreotide. 2 patients required radiological percutaneous transhepatic biliary drainage and 2 patients required surgical drainage of multiple intrabdominal collections and radiological PTBD.
CONCLUSION:
On the basis of these observations Bioglue® can be safely utilized to coat pancreatic surface after DP and pancreatico-jejunostomy after PD. This experience warrants further larger controlled studies of the potential value of Bioglue® in reducing the incidence of PF after major pancreatic surgery.