Pancreaticojejunostomy with Applicationof Fibrinogen/Thrombin-Coated Collagen Patch (TachoSil®) in Roux-en-Y Reconstruction after Pancreaticoduodenectomy

Abstract

To the Editor We read with great interest the article by Wellner and colleagues about the comparison between pancreaticogastrostomy (PG) and Roux-en-Y pancreaticojejunostomy (PJ) after pancreaticoduodenectomy (PD) with regard to postoperative pancreatic fistula (POPF) and other complications. 1 The authors concluded that PG was superior to PJ in terms of clinically relevant POPF; although this study is retrospective, the use of a large case number and standardized measures in evaluation of the surgical outcome makes the results not negligible. Instead, the results of our previously described technique of Roux-en-Y reconstruction show that PJ may have a lower prevalence of POPF than that reported by Wellner and colleagues and suggest that outcome after Roux-en-Y reconstruction with regard to POPF can be further improved using fibrinogen/thrombincoated collagen patch (TachoSil®, Nycomed, UK Ltd.) in carrying out PJ.Briefly, we reviewed the clinical records of 54 consecutive patients who underwent PD by one surgeon (P.C.) at "La Sapienza" University (Rome, Italy) from January 1995 to December 2008. The underlying diseases were: pancreatic carcinoma in 31 cases; pancreatic serous cystadenoma in six cases; mucinous cystadenoma in one case; pancreatic endocrine tumor in two cases; ampullar carcinoma in seven cases; distal bile duct carcinoma in six cases; and chronic pancreatitis in one case. In all patients, the surgical procedure comprised PD with suprapyloric gastric resection and Roux -en-Y reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct. 2

Hemostatic sponge effect on adhesion prevention in a porcine model

“…This beneficial effect on wound healing of this product was previously described in 2009 by Chirletti et al [35], who stated that HCS application to pancreatojejunal anastomosis reduced pancreatic juice spillage from the anastomosis. Additionally, an earlier report by Komatsu et al [25] declared that this product promotes wound healing process.…”

Hemostatic Agents in Hepatobiliary and Pancreas Surgery: A Review of the Literature and Critical Evaluation of a Novel Carrier-Bound Fibrin Sealant (TachoSil)

“…No subset analysis was performed of patients who received TachoComb in the suture closure and staple closure groups for determination of pancreatic fistula rate. In another series, patients undergoing open pancreaticoduodenectomy, a Roux-en-Y pancreaticojejunostomy reconstruction was reinforced with TachoSil on the pancreaticojejunal suture line [53]. There were 27 patients in each group; three patients in the non-TachoSil group had a postoperative pancreatic fistula (POPF) while only one in the TachoSil group did.…”

Pancreaticojejuno Anastomosis after Pancreaticoduodenectomy: Brief Pathophysiological Considerations for a Rational Surgical Choice

“…According to our previous works [21], we believe that two conditions are very important in the maintenance of pancreatic exocrine function after pancreaticoduodenectomy. First, gastric preservation favours adequate weight gain after surgery due to higher caloric intake.…”

“…According to these assumptions, we observed, by dynamic MR pancreatograms obtained by secretin injection, that the patency of the pancreaticojejunal anastomosis was evident in all patients evaluated [21]. In the same group, the concentration of fecal-1 elastase decreased only in the two patients with reduced jejunal filling detected by dynamic MR [21]. …”