title: Does fibrin glue sealant decrease the rate of anastomotic leak after a pancreaticoduodenectomy? Results of a prospective randomized trial.
abstract: BACKGROUND
  The aim of this study was to evaluate the effect of topical fibrin glue applied externally to all anastomoses after a pancreaticoduodenectomy (PD) on drain lipase levels, anastomotic leaks, complication rates and length of hospital stay.
  
  
  METHODS
  A standardized non-pylorus preserving PD was performed with or without fibrin glue applied to each anastomosis.
  
  
  RESULTS
  Fifty-seven patients were randomized: 32 with and 25 without TISSEEL. There were no statistical differences in each group with respect to drain lipase levels (high 40% versus 43%, P = 0.794), complications including gastric or biliary leaks (24% versus 28%, P = 1.00), wound infection (16% versus 9%, P = 0.28) and a Clavien score of 3 or more (16% versus 25%, P = 0.757) or hospital stay (12 versus 17 days, P = 0.777). Most patients with elevated drain lipase levels had an unaltered clinical course not predictive of adverse outcomes. However, the operative finding of a soft pancreas (27 out of 57 patients) was associated with post-operative complications (P = 0.002). There were no peri-operative deaths.
  
  
  CONCLUSIONS
  Fibrin glue application to all anastomoses does not alter drain lipase levels. Drain lipase levels are not a significant surrogate marker for clinically significant anastomotic leaks or complications. Fibrin glue application did not reduce the incidence of an anastomotic leak or complications.
authors: Wesley and Princess Alexandra Hospitals, Brisbane, QLD, Australia. imartin@wesley.com.au
authors: Ian
authors: I
authors: Martin
authors: Kenneth
authors: K
authors: Au
mesh_terms: D000287:Administration, Topical; D000368:Aged; D057868:Anastomotic Leak / Q000201:enzymology / Q000209:etiology / Q000517:prevention & control*; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage*; D006801:Humans; D007902:Length of Stay; D008049:Lipase / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011446:Prospective Studies; D011793:Queensland; D013530:Surgical Wound Infection / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015718:Fibrin Tissue Adhesive; D008049:Lipase; C518354:PNLIP protein, human