Effectiveness of Tachosil® in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis

Hüttner, Felix J; Mihaljevic, André L.; Hackert, Thilo; Ulrich, Alexis; Büchler, Markus W.

doi:10.1007/s00423-016-1382-7

Cited by 33 publications

(17 citation statements)

References 43 publications

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“…Although fibrin sealant patches were originally designed to improve haemostasis during surgery, there is an increasing number of publications about their tissue‐sealing properties for indications such as tightening anastomoses in gastrointestinal surgery, and sealing air leakage in pulmonary surgery, lymphatic leakage in urology and gynaecology, and cerebrospinal fluid leakage in neurosurgery. In the majority of previous studies in pancreatic surgery, sealant patches were used to cover the pancreatic stump after distal pancreatic resection.…”

Section: Discussionmentioning

confidence: 99%

“…As with fibrin glue, matrix‐bound sealants have previously shown no obvious advantage in preventing POPF in pancreatic surgery. However, most of the evidence has been obtained from distal pancreatectomy and few results have been reported for pancreatojejunostomy. The aim of the present study was to evaluate the ability of a fibrin‐coated collagen patch to reduce the risk of postoperative POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy.…”

Section: Introductionmentioning

confidence: 99%

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Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Schindl

Függer

Götzinger

et al. 2018

British Journal of Surgery

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BackgroundThe potential for a fibrin sealant patch to reduce the risk of postoperative pancreatic fistula (POPF) remains uncertain. The aim of this study was to evaluate whether a fibrin sealant patch is able to reduce POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy.MethodsIn this multicentre trial, patients undergoing pancreatoduodenectomy were randomized to receive either a fibrin patch (patch group) or no patch (control group), and stratified by gland texture, pancreatic duct size and neoadjuvant treatment. The primary endpoint was POPF. Secondary endpoints included complications, drain‐related factors and duration of hospital stay. Risk factors for POPF were identified by logistic regression analysis.ResultsA total of 142 patients were enrolled. Forty‐five of 71 patients (63 per cent) in the patch group and 40 of 71 (56 per cent) in the control group developed biochemical leakage or POPF (P = 0·392). Fistulas were classified as grade B or C in 16 (23 per cent) and ten (14 per cent) patients respectively (P = 0·277). There were no differences in postoperative complications (54 patients in patch group and 50 in control group; P = 0·839), drain amylase concentration (P = 0·494), time until drain removal (mean(s.d.) 11·6(1·0) versus 13·3(1·3) days; P = 0·613), fistula closure (17·6(2·2) versus 16·5(2·1) days; P = 0·740) and duration of hospital stay (22·1(2·2) versus 18·2(0·9) days; P = 0·810) between the two groups. Multivariable logistic regression analysis confirmed that obesity (odds ratio (OR) 5·28, 95 per cent c.i. 1·20 to 23·18; P = 0·027), soft gland texture (OR 9·86, 3·41 to 28·54; P < 0·001) and a small duct (OR 5·50, 1·84 to 16·44; P = 0·002) were significant risk factors for POPF. A patch did not reduce the incidence of POPF in patients at higher risk.ConclusionThe use of a fibrin sealant patch did not reduce the occurrence of POPF and complications after pancreatoduodenectomy with pancreatojejunostomy. Registration number: 2013‐000639‐29 (EudraCT register).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Schindl

Függer

Götzinger

et al. 2018

British Journal of Surgery

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“…comprising only 5·6 per cent of the analysed population). DP is known to result in higher rates of POPF: up to 50 per cent overall in RCTs and approximately 20 per cent of clinically meaningful POPF (grade B/C). Future trials need to assess the benefit of prophylactic drainage in DP.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of prophylactic abdominal drainage in pancreatic surgery

Hüttner

Probst

Knebel

et al. 2017

British Journal of Surgery

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“…TachoSil can be particularly useful in extended liver resection [86], decreasing bile leakage after surgery [87,88]. In pancreatic surgery, TachoSil can be safely applied to the remaining pancreas after its peripheral resection as a safe intervention, however, there are no data confirming that its use decreases the rate of postoperative pancreatic fistula, mortality, reoperation rate, blood loss and hospital stay [89]. It seems that collagen matrix covered with fibrinogen and thrombin can play a significant role in prevention of intestinal anastomotic leaks, especially in patients with multiple risk factors.…”

Section: -Application Of Medical Adhesivesmentioning

confidence: 99%

Anastomotic leaks in gastrointestinal surgery and their prevention

Banasiewicz¹,

Dziki²,

Lampe

et al. 2017

Pol Przegl Chir

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Anastomotic leak in the gastrointestinal tract is one of the most important complications of resection. They are the main cause of reoperation, their occurrence worsens the prognosis of the patient, increasing the proportion of direct mortality, as well as being a significant risk factor for recurrence of cancer. The risk of leaks within the gastrointestinal tract is greatly varied, depending on the location and extent of the resection, but also on patient, disease or a surgical procedure, including surgeon. To determine the potential risk of leakage can be significant for introduction some prophylactic actions. Some of them have the character of general recommendations, as proper nutrition of the patient in the perioperative period, while another part is directly connected to the surgical procedure. The second group includes protective stoma, the use of tissue glues, insertion transrectal drain for rectal anastomosis decompression, the use of stents or the use of collagen matrix coated with fibrinogen and thrombin. Important to reduce the proportion of leaks can be more precise and targeted prophylactic recommendations, based on the individualized determination of risk factors leaks. Further research for this purpose are necessary for this purpose, the big hope can be associated with data obtained through mobile applications.

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Effectiveness of Tachosil® in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis

Cited by 33 publications

References 43 publications

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Meta-analysis of prophylactic abdominal drainage in pancreatic surgery

Anastomotic leaks in gastrointestinal surgery and their prevention

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