Safety of a new biological adhesive after pancreatic resection

Aim. Pancreatic fistula (PF) represents the main complication (10%-29%) after pancreatic surgery. Soft pancreatic texture with a not dilated pancreatic duct represent the major risk factors for PF. Mortality after pancreaticoduodenectomy (PD) is reported in several large series to be <5%. PF and local sepsis are the main causes of delayed arterial hemorrage with a high mortality rate (14-38%). Therefore, any effort should be implemented in order to reduce the incidence of PF. Methods. In the present study we have extended the use of the biological adhesive Bioglue (R) to coat pancreatic resection surface after distal pancreasectomy (DP, N.=5) and pancreatico-jejunostomy (PJ) after PD (N.=18) in a consecuitive series of 23 patients affected by periampullary or distal pancreatic neoplasms. Results. Operative mortality was observed in 2 instances: one case after PJ leakage (1/18, 5.5%) and one case after DP not related to PF (1/5, 20%). PF has been documented in 7/23 (30,4%) after pancreatic resection, and in all cases after PD. In 3 cases PF has been successfully treated conservatively by NPO and octreotide. 2 patients required radiological percutaneous transhepatic binary drainage and 2 patients required surgical drainage of multiple intrabdorninal collections and radiological PTBD. Conclusion. On the basis of these observations Bioglue can be safely utilized to coat pancreatic surface after DP and pancreaticojejunostomy after PD. This experience warrants further larger controlled studies of the potential value of Bioglue (R) in reducing the incidence of PF after major pancreatic surgery.