Backgrounds and aims: Mortality after pancreaticoduodenectomy (PD) in high volume centers had decreased to less than 2%. However, morbidity still remains considerably high, ranging 20-50%. The most frequent cause of morbidity is pancreatic fistula (PF) in early postoperative period. Polyglicolic acid (PGA) felt is bioabsorbable recombinant membrane. It is easily shaped and it rapidly reacts with fibrin glue. PGA felt combined with fibrin glue as the topical agent have been reported to be successful in prevention of bile leakage after liver resection compared with fibrin glue alone. PGA felt combined with fibrin glue is also reported to be useful in preventing air leakage after lung surgery and cerebrospinal leakage after spinal surgery. The aim of this study was to assess the efficacy of PGA felt combined with fibrin glue as an adjunct of pancreaticoenterostomy for prevention of postoperative PF following PD.
Method: PGA felt combined with fibrin glue as an adjunct of pancreaticoenterostomy were applied prospectively to 20 consecutive patients undergoing pancreaticoduodenectomy. The pancreatic anastomosis was reconstructed with a duct-to-mucosa pancreaticogastrostomy into the posterior wall of the stomach. Internal pancreatic duct stenting were used in all cases. No prophylactic octreotide was administered in this study. Drain amylase were measured daily after the surgery until drain was removed on the postoperative day 5. The incidence of postoperative pancreatic fistula and other postoperative complication were recorded. Pancreatic fistula was defined as drain output amylase levels greater than 3 times than the upper normal serum amylase value on or after postoperative day3 and graded according to the International Study Group Pancreatic Fistula definition.
Results: There were 11 males and 9 females (mean age 65 +/- 15). The mean operative time was 351 +/- 75 minutes. The pancreatic texture of the stump was “soft” in 16 cases. The median of the level of amylase in drain were 745 U/l on POD1, 427 U/l on POD2, 97 U/l on POD3, and 38 U/l on POD5. Only one patient (5%) developed grade A postoperative PF. The incidence of PF with clinically significant impact (grade B+C) was 0%. No patients required a change in management or adjustment in the clinical pathway. Other postoperative complications include one wound infection(5%) and one bile leakage (5%). Patient did not present any side effects related to the PGA and fibrin glue. There was no percutaneous drainage, readmission and reoperation. There was no mortality.
Conclusions: Combination of bioabsorbable PGA felt and fibrin glue was extremely favorable for prevention of postoperative PF following PD.