Use of fibrin glue sealant with polyglycolic acid sheets to prevent pancreatic fistula formation after laparoscopic-assisted gastrectomy.
OBJECTIVE
A pancreatic fistula is a serious postoperative complication that can occur after gastrectomy with lymphadenectomy for gastric cancer. The aim of this prospective study was to analyze the usefulness of the local application of fibrin glue sealant (FG) and polyglycolic acid sheets (PAS) in preventing pancreatic fistula formation after gastrectomy.


METHODS
The surface of the pancreas was covered with FG and PAS after peri-pancreatic lymph node dissection in 34 patients (F/P group). The postoperative outcome was compared with historical control subjects who did not receive the same application (control group, 64 patients).


RESULTS
A pancreatic fistula occurred in three patients in the control group but in none the F/P group (P = 0.049). The volume of drainage fluid on postoperative day (POD) 1 and 3 was smaller in the F/P group than in the control group (POD1: F/P group, 80 ml; control: 150 ml, P < 0.001; POD3: 60 vs. 120 ml, P < 0.001). The amylase levels in the drainage fluid on POD1 and 3 were also significantly lower in the F/P group than in the control group (POD1: F/P group, 660 U/L; control: 1220 U/L, P = 0.030; POD2: 270 vs. 830 U/L, P = 0.038; POD3, 160 vs. 630 U/L, P = 0.041).


CONCLUSIONS
The application of FG and PAS after LAG helps to prevent pancreatic fistula formation.
Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka 565-0871, Japan.
Yuichiro
Y
Hiura
Shuji
S
Takiguchi
Kazuyoshi
K
Yamamoto
Yukinori
Y
Kurokawa
Makoto
M
Yamasaki
Kiyokazu
K
Nakajima
Hiroshi
H
Miyata
Yoshiyuki
Y
Fujiwara
Masaki
M
Mori
Yuichiro
Y
Doki
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000369:Aged, 80 and over; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010185:Pancreatic Fistula / Q000517:prevention & control*; D011100:Polyglycolic Acid / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D055815:Young Adult
D015718:Fibrin Tissue Adhesive; D011100:Polyglycolic Acid