Introduction This study evaluated the effect of fibrin glue applied as a sandwich film between a two layer pancreatico-jejunostomy anastomosis following pancreaticoduodenectomy. Primary end-points were post-operative pancreatic fistulae, overall complication rates and post-operative length of stay. Methods Pancreaticoduodenectomy was performed by fashioning a two layer pancreatico-jejunostomy with or without a glue sealant which when applied, formed a thin film external to the ductal anastomosis but internal to the seromuscularpancreatic parenchymal layer. Results Following audit of 100 consecutive patients undergoing pancreaticoduodenectomy, patients were separated into two groups; those with glue augmented anastomosis [Glue (G) N=50] or those without [No Glue (NG), N=50]. Each group was matched with regard to age [median, G=68 years vs. NG=66 years, (P=0.19)] and sex (P=0.84). There were no statistically significant differences between the two groups with respect to overall POPF [G N=7(14%) vs. NG N=11(22%), (P=0.42)], significant complications (Clavien Grade 3 or more), [G N=4(8%) vs. NG N=2(4%) (P=0.40)], or post-operative length of stay [G 13 days vs. NG 14 days, (P=0.90)]. In those patients with the highest fistulae risk score, there were significantly more post-operative pancreatic fistulae in the no glue cohort. There was no mortality in either group. Conclusion This study shows that application of sealant glue significantly reduces post-operative pancreatic fistulae in high-risk patients, but does not reduce overall complications or hospital stay following pancreaticoduodenectomy.
Shafiq Rehman, Bryon C Jaques