Temporary Fibrin Glue Occlusion of the Main Pancreatic Duct in the Prevention of Intra-Abdominal Complications After Pancreatic Resection

Increased awareness of periampullary & pancreatic head cancers, and the accompanying improved outcomes following pancreatoduodenectomy (PD), has possibly led to an increase in patients seeking treatment for the same. While there has definitely been a reduction in morbidity rates following PD in the last few decades, this decline has not mirrored the drastic fall in mortality. Amongst the foremost in the factors responsible for this reduction in mortality is the standardization of surgical technique and development of dedicated teams to manage all aspects of this demanding procedure. This review intends to provide the reader with an overview of major complications following this major surgery and measures to prevent them based on the authors' experience.

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“…Pancreaticoenteric anastomosis is necessary to avoid severe exocrine and endocrine deficiencies [49][50][51]. Tran et al…”

Section: Pancreaticoenteric Anastomosismentioning

confidence: 99%

Pancreatoduodenectomy - Preventing Complications

Penumadu

Barreto

Goel

et al. 2014

Indian J Surg Oncol

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“…A great number of surgical techniques and instruments for treating the resected pancreatic surface and preventing pancreatic fistula after DP has been proposed: hand-sewn suture [2,11] , stapler [1,2,7,11] , a combination of stapler and suture [2,7,11] , the use of pledgetted suture [7] , fibrin-glue sealing [12,13] , and prolamine injection [14] . The most commonly used techniques of pancreatic remnant management are the stapler and suture closure.…”

Section: T a B L E 4 I N C I D E N C E O F P A N C R E A T I C F I S mentioning

confidence: 99%

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Ridolfini

Alfieri²,

Gourgiotis³

et al. 2007

WJG

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AIM:To identify risk factors related to pancreatic fistula in patients undergoing distal pancreatectomy (DP) and to determine the effectiveness of using a stapled and a sutured closed of pancreatic stump. METHODS:Sixty-four patients underwent DP during a 10-year period. Information regarding diagnosis, operative details, and perioperative morbidity or mortality was collected. Eight risk factors were examined. RESULTS:Indications for DP included primary pancreatic disease (n = 38, 59%) and non-pancreatic malignancy (n = 26, 41%). Postoperative mortality and morbidity rates were 1.5% and 37% respectively; one patient died due to sepsis and two patients required a reoperation due to postoperative bleeding. Pancreatic fistula was developed in 14 patients (22%); 4 of fistulas were classified as Grade A, 9 as Grade B and only 1 as Grade C. Incidence of pancreatic fistula rate was significantly associated with four risk factors: pathology, use of prophylactic octreotide therapy, concomitant splenectomy, and texture of pancreatic parenchyma. The role that technique (either stapler or suture) of pancreatic stump closure plays in the development of pancreatic leak remains unclear. CONCLUSION:The pancreatic fistula rate after DP is 22%. This is reduced for patients with non-pancreatic malignancy, fibrotic pancreatic tissue, postoperative prophylactic octreotide therapy and concomitant splenectomy.

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“…However, even though the absence of an anastomosis of the pancreatic remnant may prevent many postoperative complications, the occlusion of the pancreatic stump with synthetic/biological substances or sutures has not been widely accepted due to a high percentage of pancreatic fistula (sometimes more than 50%) and postoperative collections 3 . Additionally, an increase risk of exocrine 4 and endocrine pancreatic insufficiency cannot be ruled out 5 .…”

Section: Introductionmentioning

confidence: 99%

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

Quesada¹,

Burdı́o²,

Iglesias³

et al. 2015

Pancreatology

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Methods: Thirty-two rats were subjected to RFA and section of the pancreas over their portal vein. Animals were killed at 3, 7, 15 and 21 days (Groups 0-3, respectively). Two additional control groups (sham operation and user manipulation only, respectively) of 15 days of postoperative period were considered. Postoperative complications, histological changes (including morphometric and immunohistochemical analysis) and incidence of POPF were evaluated.Results: A significant increase in serum amylase levels (p<0.05) on the 3 rd postoperative day which return to baseline levels in the following weeks was noted in groups 0-3. Those groups showed a rapid atrophy of the distal pancreas by apoptosis with no signs of necrotizing pancreatitis or POPF. The distal pancreas in groups 1-3 compared to group 0 and control groups showed a significant increase of small islets (<1000 μm 2 ). Conclusions:The rapid acinar atrophy of the distal pancreas after RFA and section of the pancreatic ducts in this model does not lead to necrotizing pancreatitis.

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Temporary Fibrin Glue Occlusion of the Main Pancreatic Duct in the Prevention of Intra-Abdominal Complications After Pancreatic Resection

Abstract: Ductal occlusion by intracanal injection of fibrin glue decreases neither the rate nor the severity of intra-abdominal complications after pancreatic resection.

Cited by 252 publications

References 28 publications

Pancreatoduodenectomy - Preventing Complications

Pancreatoduodenectomy - Preventing Complications

Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial?

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

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