The using of sealants in pancreatic surgery: A Systematic Review

Abstract

Background POPF derives from the pancreatic stump, which follows pancreatic resection and the pancreatoenteric anastomosis following pancreaticoduodenectomy. Since 1978 sealants have been used in pancreatic surgery to prevent pancreatic fistula after resection of the pancreatic head and tail or for the management of trauma and the treatment of low-output pancreatic fistula. Different types of fibrin sealants have been evaluated for their potential to reduce the occurrence of POPF. Methods A systematic search of the electronic literature was performed using PubMed, Cochrane Library, and Scopus databases to obtain access to all publications, especially clinical trials, randomised controlled trials, and systematic reviews concerning fibrin sealants pancreatic surgery. Searching for “fibrin sealants pancreas,” we found a total of 73 results on Pubmed, 61 on Scopus, and 14 on Cochrane Library (148 total results). Results Eighteen studies were found on literature, following the criteria already described, concerning the use of fibrin sealants in pancreatic surgery. All articles described were published in the period between 1989 and 2019. Most of these were single centre studies. A total of 1032 patients were enrolled in this review. In the studies, sealants were used to reinforce pancreatic anastomoses and for the occlusion of the main pancreatic duct. Conclusion CR-POPF is a fearful complication of pancreatic surgery; among the possible solutions to reduce the risk of onset, sealants were used on the pancreatic stump; today the sealants should be considered such as an option to reduce the CR-POPF, but the routine use in clinical practice has to be validated.

“Mitigation strategies for post-operative pancreatic fistula after pancreaticoduodenectomy in high-risk pancreas: an evidence-based algorithmic approach”—a narrative review

“…Regarding the adjuvant strategies like tissue patches and sealants; patches and sealants were not able to decrease the incidence of CR-POPF in high-risk scenarios. This was uniformly seen in the RCTs, Cochrane review, and multicenter studies (101)(102)(103)(104)(105)(106).…”

Effect of artificial or autologous coverage of the pancreatic remnant or anastomosis on postoperative pancreatic fistulas after partial pancreatectomy: meta-analysis of randomized clinical trials

“…In the present meta-analysis, care was taken to include only RCTs with autologous or artificial coverage as the only intervention; furthermore, only RCTs were included in the present meta-analysis. In contrast, previous meta-analyses obtained most of their data from retrospective, non-randomized studies 7 , 9 , 10 , 12 , 40 . Like the limited study populations in previous RCTs, the power of former meta-analyses was reduced by a low number of RCTs.…”

Polyethylene glycol-coated haemostatic patch for prevention of clinically relevant postoperative pancreatic fistula after pancreatoduodenectomy: randomized clinical trial

“…The use of sealants may be an option to reduce the incidence of POPF and, therefore, reducing life-threatening complications and healthcare costs 3 , 4 . Although the use of different sealants and acrylic glues has not provided unequivocal data on their ability to reduce the incidence of POPF in patients undergoing PD 3 , 13–17 , relevant differences in the study protocol, sealant characteristics, and surgical procedures/techniques may have a significant impact on the outcomes.…”

“…Although the use of different sealants and acrylic glues has not provided unequivocal data on their ability to reduce the incidence of POPF in patients undergoing PD 3 , 13–17 , relevant differences in the study protocol, sealant characteristics, and surgical procedures/techniques may have a significant impact on the outcomes. Moreover, current scientific evidence suggests that, in patients who undergo a PD, fibrin sealants make little to no difference to the POPF rate or mortality compared with control 4 .…”

“…Despite improvements in perioperative management and surgical techniques, aiming to decrease the incidence of POPF formation through the use of somatostatin analogues, pancreatic stents, minimally invasive surgery, reinforcement of the anastomosis with glue, autologous tissues, non-autologous absorbable or non-absorbable materials, no differences in POPF rates have been reported over the last decade 3 , 4 , 7–10 . This issue has been attributable to the fact that the underlying mechanism of POPF has not been fully elucidated, and other factors different from mechanical alterations of the pancreatoenteric anastomosis are involved in the process 11 .…”