title: Topically applied 2-octyl cyanoacrylate (Dermabond) for prevention of postoperative pancreatic fistula after pancreaticoduodenectomy.
abstract: OBJECTIVE
  We examined whether 2-octyl cyanoacrylate (Dermabond) topically applied to the pancreaticojejunostomy (PJ) anastomotic site after pancreaticoduodenectomy (PD) reduces the rate of postoperative pancreatic fistula (POPF).
  
  
  METHODS
  Patients who underwent PD with duct-to-mucosa PJ were evaluated (n = 124). Outcome was compared between patients who received Dermabond (n = 75) after PD and historic patients who did not (n = 49). Risk factors for POPF were identified.
  
  
  RESULTS
  Overall and clinically relevant rates of POPF were significantly lower in patients who received Dermabond than in patients who did not (2.6 % and 1.3 % vs. 22 % and 12 %, respectively; p = 0.001). In univariate analysis, pancreatic duct diameter ≤3 mm, low serum albumin level, and no Dermabond were independent risk factors for POPF; in multivariate analysis, no Dermabond was an independent risk factor for POPF. In patients with pancreatic duct diameter ≤3 mm, the rate of POPF was significantly lower in patients who received Dermabond than in patients who did not (3.5 % versus 36 %, respectively; p = 0.0001). Patients who received Dermabond had significantly shorter hospital stays and lower re-operation and re-admission rates.
  
  
  CONCLUSIONS
  Topical application of Dermabond to the PJ anastomotic site after PD significantly reduced the rate of POPF, particularly in patients at risk.
authors.affiliation: Department of General, Hepatobiliary, and Pancreatic Surgery, St. Luke's Episcopal Hospital, 6624 Fannin Suite 2180, Houston, TX 77030, USA. omarbarakat@sbcglobal.net
authors.forename: Omar
authors.initials: O
authors.lastname: Barakat
authors.forename: Claire F
authors.initials: CF
authors.lastname: Ozaki
authors.forename: R Patrick
authors.initials: RP
authors.lastname: Wood
mesh_terms: D000287:Administration, Topical; D000368:Aged; D003487:Cyanoacrylates / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016577:Pancreaticoduodenectomy; D010193:Pancreaticojejunostomy / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D012307:Risk Factors; D014014:Tissue Adhesives / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives; C100832:octyl 2-cyanoacrylate