Application of polyethylene glycolic acid felt with fibrin sealant to prevent postoperative pancreatic fistula in pancreatic surgery.
OBJECTIVE
The purpose of this nonrandomized retrospective study was to report our new procedures using polyethylene glycolic acid (PGA) felt with fibrin sealant to prevent severe pancreatic fistula in patients undergoing pancreatic surgery.


METHODS
From 2000 to 2008, 54 and 63 patients underwent pancreaticoduodenectomy (PD) and distal pancreatectomy (DP), respectively. Of those patients, we applied PGA felt with fibrin sealant to 18 PD patients and 26 DP patients. In PD patients, the PGA felt was wrapped around the pancreatic suture site, while in DP patients, the PGA felt was wrapped around the predictive division site. The pancreaticojejunostomy site in PD patients and the cut stump in DP patients were coated with fibrin sealant. We compared the occurrence rates for severe postoperative pancreatic fistula (POPF) that occurred after PD or DP both with and without our new procedures.


RESULTS
Before introduction of our procedures, severe POPF developed in 14 of 36 PD patients (39%) and 10 of 37 DP patients (27%). In contrast, after introduction of our procedures, the incidence of POPF was only one in both of 18 PD (6%; P = 0.016) and 26 DP (4%; P = 0.017) patients.


CONCLUSIONS
In summary, our procedure using PGA felt with fibrin sealant may reduce the risk of severe POPF.
Ochiai
Toshiya
T
Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 6028566, Japan. tochiai@koto.kpu-m.ac.jp
Sonoyama
Teruhisa
T
Soga
Koji
K
Inoue
Koji
K
Ikoma
Hisashi
H
Shiozaki
Atsushi
A
Kuriu
Yoshiaki
Y
Kubota
Takeshi
T
Nakanishi
Masayoshi
M
Kikuchi
Shojiro
S
Ichikawa
Daisuke
D
Fujiwara
Hitoshi
H
Sakakura
Chouhei
C
Okamoto
Kazuma
K
Kokuba
Yukihito
Y
Otsuji
Eigo
E
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology*; D005500:Follow-Up Studies; D006016:Glycolates / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D010193:Pancreaticojejunostomy / Q000009:adverse effects* / Q000379:methods; D020959:Polyethylene / Q000494:pharmacology; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013526:Surgical Mesh; D016019:Survival Analysis; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive; D006016:Glycolates; C031149:glycolic acid; D020959:Polyethylene