Distal Pancreatectomy with Autologous Fibrin Sealant - Implementation of an Established Concept of Tissue Sealing in Pancreatic Surgery

• Published in: Zentralblatt fur Chirurgie Vol. 141; no. 6; p. 625
• Main Authors: Luu, A M, Braumann, C, Belyaev, O, Janot, M, Uhl, W, Herzog, T
• Format: Journal Article
• Language: German
• Published: Germany 01-12-2016
• Subjects: Adult; Aged; Female; Fibrin Tissue Adhesive - therapeutic use; Humans; Male; Middle Aged; Pancreatectomy - methods; Pancreatic Fistula - classification; Pancreatic Fistula - prevention & control; Pancreatic Fistula - therapy; Pancreatic Neoplasms - secondary; Pancreatic Neoplasms - surgery; Pancreatitis, Chronic - surgery; Postoperative Complications - prevention & control; Treatment Outcome
• ISSN: 1438-9592
• DOI: 10.1055/s-0042-109979

Postoperative pancreatic fistulas (POPF) remain a major concern after distal pancreatectomy. Irrespective of the technique to close the pancreatic remnant, pancreatic fistulas will occur in approximately 30 % of patients undergoing distal pancreatectomy. For the first time ever, autologous fibrin sealant (Vivostat®) was used to additionally seal the pancreatic remnant after a distal pancreatectomy. The aim was to analyse whether this changes the postoperative outcome.
In 2015, a technical case series was performed in 15 patients who underwent distal pancreatectomy. The pancreatic remnant was additionally sealed with autologous fibrin sealant (Vivostat®).
A postoperative pancreatic fistula (POPF) occurred in 5/15 patients (33 %). One patient had a POPF grade A (1/15, 6.7 %), whereas a POPF grade B occurred in 4/15 patients (26.7 %). 75 % (3/4) of the patients with a POPF grade B were sufficiently treated with antibiotics, whereas a CT-guided percutaneous drainage had to be placed only in one case.
Autologous fibrin sealant is simple to apply and seems to be well tolerated. However, it does not seem to avoid the development of postoperative pancreatic fistulas after distal pancreatectomy.