title: Pancreatic fistula after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis: effect of fibrin glue and polyglycolic acid felt on prophylaxis of postoperative complications.
abstract: BACKGROUND
  This study aimed to determine the effect of fibrin glue and polyglycolic acid (PGA) felt on prevention of pancreatic fistula (PF) after laparoscopic splenectomy in patients with hypersplenism due to liver cirrhosis.
  
  
  METHODS
  Fifty consecutive patients were enrolled in this prospective study. Twenty-three patients underwent laparoscopic splenectomy with a fibrin sheet (fibrin sheet group). The sealing ability of each treatment was evaluated by an ex vivo pressure test model. Based on the results from ex vivo experiments, 27 patients received prophylaxis using fibrin glue and PGA felt (PGA with fibrin group). The primary endpoint was the incidence of PF.
  
  
  RESULTS
  Significantly more (5, 22%) patients developed PF in the fibrin sheet group than in the PGA with fibrin group (0%, P = .037).
  
  
  CONCLUSIONS
  Our new application of fibrin glue and PGA felt is an effective prophylactic procedure for preventing development of PF after laparoscopic splenectomy.
authors.affiliation: Department of Surgery, Center for Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan. Electronic address: tnori@surg2.med.kyushu-u.ac.jp.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Tsutsumi
authors.affiliation: Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Morimasa
authors.initials: M
authors.lastname: Tomikawa
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Akahoshi
authors.affiliation: Clinical Research Institute, National Hospital Organization, Beppu Medical Center, Beppu, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.affiliation: Department of Surgery, Center for Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Surgery, Center for Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sakaguchi
authors.affiliation: Department of Surgery, Center for Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kusumoto
authors.affiliation: Department of Surgery, Center for Gastroenterology, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka 810-8563, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Ikejiri
authors.affiliation: Department of Advanced Medicine and Innovative Technology, Kyushu University Hospital, Fukuoka, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Hashizume
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011322:Primary Prevention / Q000379:methods; D011446:Prospective Studies; D018570:Risk Assessment; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D015718:Fibrin Tissue Adhesive; D011100:Polyglycolic Acid
keywords: Fibrin glue; Hypersplenism; Laparoscopic splenectomy; Pancreatic fistula; Polyglycolic acid felt; Postoperative complications