title: Role of TachoSil® in distal pancreatectomy: a single center experience.
abstract: OBJECTIVE
  Distal pancreatectomies (DP) are associated with high risk of postoperative complications, and in many series higher morbidity rate than duodenopancreatectomies has been reported. To evaluate the role of a collagen sponge with human fibrinogen and thrombin film (TachoSil®) in limiting the incidence of complications after DP.
  
  
  METHODS
  From 1996 to 2013, 221 patients have been submitted to distal pancreatectomy (± splenectomy) in our Division. A retrospective analysis has been conducted in a group of 36 consecutive and prospectively collected DP treated with intraoperative placement of TachoSil® on pancreatic stump from 2010 to 2013 (group 1). A control series of 36 consecutive patients (group 2) was matched 1:1 from hystorical database. The variables considered in the analysis were: age, gender, ASA score, pancreatic texture (hard vs. soft), histology, operative time, postoperative mortality, morbility (postoperative pancreatic fistula - POPF, postoperative hemorrage - PPH, delayed gastric emptying - DGE) and hospital stay. Differences between POPF, PPH, DGE and hospital stays between grops were investigated with χ² and t-Student test. Univariate analysis was conducted to determine factors related to POPF development. Statistical analysis was performed using freeware Microsoft Excel based program.
  
  
  RESULTS
  Post operative mortality was 0% in both groups. POPF were registered in 36.1% (13/36) and 41.6 % (15/36) in groups 1 and 2, respectively (P=n.s.); in group 1 we didn't observe grade C POPF, while 4 patients in control group developed grade C POPF (P<0,05). No differences were found between two groups in terms of incidence of PPH and DGE. The median duration of postoperative hospital stay in group 1 was 21.8 (7-189) days compared with 31.13 (9-249) days in group 2 (P<0.001).
  
  
  CONCLUSIONS
  The use of TachoSil® seems to be associated with lower incidence of grade C POPF but larger controlled trials are needed to surely assess the usefulness of TachoSil® in pancreatic surgery in order to reduce pancreatic specific complications and their severity.
authors.affiliation: 4th General Surgery Department, A.O.U. Città della Salute e della Scienza, Turin, Italy - afranchello@cittadellasalute.to.it.
authors.forename: S
authors.initials: S
authors.lastname: Silvestri
authors.forename: A
authors.initials: A
authors.lastname: Franchello
authors.forename: F
authors.initials: F
authors.lastname: Gonella
authors.forename: G
authors.initials: G
authors.lastname: Deiro
authors.forename: D
authors.initials: D
authors.lastname: Campra
authors.forename: D
authors.initials: D
authors.lastname: Cassine
authors.forename: A
authors.initials: A
authors.lastname: Fiore
authors.forename: E
authors.initials: E
authors.lastname: Ostuni
authors.forename: M
authors.initials: M
authors.lastname: Garino
authors.forename: A
authors.initials: A
authors.lastname: Resegotti
authors.forename: E C
authors.initials: EC
authors.lastname: Farina
authors.forename: G R
authors.initials: GR
authors.lastname: Fronda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects; D010185:Pancreatic Fistula / Q000517:prevention & control; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013917:Thrombin / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C518955:TachoSil; D005340:Fibrinogen; D013917:Thrombin