Background: Pancreatic fistula complicates up to 15-25% of pancreatic resections, especially with soft, normal pancreas, and is most common after distal pancreatectomy. A new synthetic, absorbable hydrogel sealant has recently been developed and tested for sealing of lung, aorta, bronchi, and dura. Our objective was to test the efficacy of the sealant in preventing pancreatic leaks in a dog model of distal pancreatectomy.
Methods: After an overnight fast, eight normal dogs underwent exploratory laparotomy and bilateral distal pancreatectomy under general endotracheal anesthesia. The animals were randomized to receive application of the sealant to the pancreatic stumps (n=4) or no treatment (n=4). The transected pancreatic duct was not ligated and the end of the pancreas was neither oversewn nor stapled; this open pancreatic stump is thus an extreme test of the sealant. Closed-suction drains were placed in proximity to the pancreatic stumps prior to abdominal closure. All animals received normal chow starting on the first postoperative day. Drainage was collected for volume and amylase determination twice daily for 14 days postoperatively. On the 14th postoperative day, the animals were sacrificed with pentobarbital overdose and the abdomen was reexplored. Pancreatic tissue was collected from the area of transection and formalin-fixed for histopathology.
Results: There was no perioperative mortality. Fluid recovered from closed-suction drains in all animals was uniformly amylase-rich (amylase > 500 U/L). Over the 14-day study period, the daily volume of pancreatic drainage was significantly different between the control animals and animals treated with sealant (p<0.001 by two-way ANOVA). By postoperative day 8, the total mean pancreatic drainage in dogs treated with sealant was 15±8 ml (vs. 111±48 ml in untreated dogs), at which point we remove the drains in clinical practice. Examination at 14 days revealed intact sealant at the pancreatic stumps in the treatment group. Histopathology showed a characteristic benign histiocyte reaction to the sealant but no other qualitative differences in the degree of inflammation between control and treatment animals. There were no undrained collections or abscesses.
Conclusions: A new synthetic hydrogel sealant prevents the formation of significant pancreatic fistula after distal pancreatectomy in normal dogs even without ligation of the pancreatic duct or closure of the pancreatic remnant.