title: Systematic review and meta-analysis of fibrin sealants for patients undergoing pancreatic resection.
abstract: BACKGROUND
  Post-operative pancreatic fistula (POPF) is a common complication after partial pancreatic resection, and is associated with increased rates of sepsis, mortality and costs. The role of fibrin sealants in decreasing the risk of POPF remains debatable. The aim of this study was to evaluate the literature regarding the effectiveness of fibrin sealants in pancreatic surgery.
  
  
  METHODS
  A comprehensive database search was conducted. Only randomized controlled trials comparing fibrin sealants with standard care were included. A meta-analysis regarding POPF, intra-abdominal collections, post-operative haemorrhage, pancreatitis and wound infections was performed according to the recommendations of the Cochrane collaboration.
  
  
  RESULTS
  Seven studies were included, accounting for 897 patients. Compared with controls, patients receiving fibrin sealants had a pooled odds ratio (OR) of developing a POPF of 0.83 [95% confidence interval (CI): 0.6-1.14], P = 0.245. There was a trend towards a reduction in post-operative haemorrhage (OR = 0.43 (95%CI: 0.18-1.0), P = 0.05) and intra-abdominal collections (OR = 0.52 (95%CI: 0.25-1.06), P = 0.073) in those patients receiving fibrin sealants. No difference was observed in terms of mortality, wound infections, re-interventions or hospital stay.
  
  
  CONCLUSIONS
  On the basis of these results, fibrin sealants cannot be recommended for routine clinical use in the setting of pancreatic resection.
authors: Division of Visceral and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
authors: Lorenzo A
authors: LA
authors: Orci
authors: Graziano
authors: G
authors: Oldani
authors: Thierry
authors: T
authors: Berney
authors: Axel
authors: A
authors: Andres
authors: Gilles
authors: G
authors: Mentha
authors: Philippe
authors: P
authors: Morel
authors: Christian
authors: C
authors: Toso
mesh_terms: D015718:Fibrin Tissue Adhesive / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016017:Odds Ratio; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality; D010185:Pancreatic Fistula / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D018579:Patient Selection; D012307:Risk Factors; D014014:Tissue Adhesives / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives