Background Bio‐absorbable sealants are widely used to reduce the rate and severity of postoperative pancreatic fistulas after distal pancreatectomy. However, numerous clinical trials have failed to demonstrate their clinical benefit. We therefore investigated stability and bio‐compatibility of absorbable sealants in vitro and in vivo. Methods In vitro, polymerized compounds were incubated in pancreatic juice before their stability was tested. In vivo, two compounds were used to seal the pancreatic stump after distal pancreatectomy in nine pigs. Burst pressure of the pancreatic stump, surgical outcome, histology of the pancreatic stump, systemic inflammation, and drain fluid was examined. Results Products based on fibrin or collagen were unstable in the presence of active pancreatic enzymes and completely dissolved within 2 h. Sealants using chemical cross‐linking of proteins showed improved stability for 7 days. In vivo, application of polyethylenglycol‐based sealant leads to complete closure of the pancreatic duct after 5 days, while a glutaraldehyde‐based sealant prevented physiological closure of the pancreatic main duct. Conclusions Many compounds used clinically to reinforce the pancreatic stump after distal pancreatectomy are inadequate due to instability in the presence of pancreatic enzymes. While selected bio‐absorbable sealants inhibited the natural healing of the pancreatic stump, polyethylenglycol‐based sealants should be tested in further clinical trials.

Background: Hemostasis products are used in clinical practice for sealing the pancreatic stump after distal pancreatectomy. The aim was to examine this technique. Methods: In vitro, hemostasis products were exposed to enterokinase activated pancreatic juice for up to 7 days and physical stability was determined at different times. In vivo laparoscopic assisted distal pancreatectomy was conducted in nine pigs. Closure of the stump was either obtained by Sealant A (based on glutaraldehyd), Sealant B (based on two polyethylenglycols) or no closure at all. On POD#5 animals were sacrificed and the stability of pancreatic stump closure was evaluated by burst pressure experiments. Histology and immunohistochemistry was performed. Results: All hemostasis products based on collagen or fibrin completely lost their integrity in activated pancreatic juice in less than 6 hours. In vitro, two sealants showed acceptable stability in activated pancreatic juice on day 7 (S_A: 578mmHg AE90; S_B: 126 mmHg AE15). In vivo, burst pressure applied to the pancreatic duct confirmed the macroscopically visible lack of adherence of S_A with a significant lower burst pressures than S_B and control animals (S_A 81 AE24 mmHg, S_B 242 AE12 mmHg, control 218 AE7 mmHg p<0.05). Conclusion: Hemostasis products on basis of fibrin or collagen are not suitable to prevent POPF after pancreas resection. Polyethylenglycol based sealants may have the capability to support healing of the pancreatic stump after distal pancreatectomy.

prior to surgery. Eighteen patients had no signs of irresectability during SL; the primary tumor was resected in 16 patients. Two out of 8 patients with a follow-up >6 months after resection developed liver metastases. Conclusion: Despite current preoperative imaging modalities, metastases are still identified during surgery. The current study shows limited added value of LUS and LFI during SL in pancreatic cancer patients. A total of 25 patients will be included and additional follow-up will be available for presentation.