Pancreaticojejunostomy with Applicationof Fibrinogen/Thrombin-Coated Collagen Patch (TachoSil(R)) in Roux-en-Y Reconstruction after Pancreaticoduodenectomy.

Briefly, we reviewed the clinical records of 54 consecutive patients who underwent PD by one surgeon (P.C.) at “La Sapienza” University (Rome, Italy) from January 1995 to December 2008. The underlying diseases were: pancreatic carcinoma in 31 cases; pancreatic serous cystadenoma in six cases; mucinous cystadenoma in one case; pancreatic endocrine tumor in two cases; ampullar carcinoma in seven cases; distal bile duct carcinoma in six cases; and chronic pancreatitis in one case. In all patients, the surgical procedure comprised PD with suprapyloric gastric resection and Roux -en-Y reconstruction with anastomosis of the isolated Roux limb to the stomach and single Roux limb to both the pancreatic stump and hepatic duct. Pancreaticojejunal end-to-end anastomosis was done by simple invagination of the pancreatic stump into the jejunal loop for 2 cm and sutured all around with a single- layer interrupted pledget-supported Ticron stitches between the seromuscularis of the jejunum and the pancreatic capsule. From January 2005, TachoSil® has been layered on suture line of pancreaticojejunal anastomosis (Fig. 1c, d). All 27 consecutive patients had pancreaticojejunostomy without TachoSil® (group A) whereas 27 consecutive patients had pancreaticojejunostomy with TachoSil® (Group B). All patients in our study received octreotide during the first six postoperative days. Although the differences between groups were significant (Fisher’s exact test: two-tailed P=0.6104), our preliminary experience suggests possible advantages of TachoSil® in the prevention of POPF.