Pancreaticojejunostomy using a fibrin adhesive sealant (TachoComb) for the prevention of pancreatic fistula after pancreaticoduodenectomy.

Abstract

BACKGROUND/AIMS: Pancreatic fistula is a common complication following pancreaticoduodenectomy. A number of technical modifications aimed to improve the pancreato-enteric anastomosis technique have been reported. The aim of this study was to evaluate the safety of TachoComb fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy. METHODOLOGY: Between 2005 to 2009, 40 patients (28 men and 12 women) underwent duct-to-mucosa pancreaticojejunostomy using a fibrin adhesive (TachoComb) sealing method after pancreaticoduodenectomy (either pylorus-preserving or modified Child's methods). The mean age was 67.9 years (range of 49 to 80 years). RESULTS: The overall postoperative rates of mortality and morbidity were 0.0% and 35.0%, respectively. Following the classification system described by the International Study Group on Pancreatic Fistula, 5 patients (12.5%) had Grade A pancreatic fistulas and 3 patients (7.5%) had Grade B pancreatic fistulas. There were no patients with Grade C pancreatic fistulas, and no cases of postoperative hemorrhage. No significant difference in the length of postoperative hospital stay was observed in patients with or without pancreatic fistulas. CONCLUSIONS: The use of TachoComb fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy is safe, reliable for the prevention of pancreatic fistula, and shows promise for all types of reconstruction following pancreaticoduodenectomy.