Systematic review on the use of matrix bound sealants in pancreatic resection

Smits, F. Jasmijn; Santvoort, Hjalmar C. van; Besselink, Marc G.; Rinkes, Inne H.M. Borel; Molenaar, I.

doi:10.1111/hpb.12472

Cited by 16 publications

(12 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although fibrin sealant patches were originally designed to improve haemostasis during surgery, there is an increasing number of publications about their tissue‐sealing properties for indications such as tightening anastomoses in gastrointestinal surgery, and sealing air leakage in pulmonary surgery, lymphatic leakage in urology and gynaecology, and cerebrospinal fluid leakage in neurosurgery. In the majority of previous studies in pancreatic surgery, sealant patches were used to cover the pancreatic stump after distal pancreatic resection.…”

Section: Discussionmentioning

confidence: 99%

“…As with fibrin glue, matrix‐bound sealants have previously shown no obvious advantage in preventing POPF in pancreatic surgery. However, most of the evidence has been obtained from distal pancreatectomy and few results have been reported for pancreatojejunostomy. The aim of the present study was to evaluate the ability of a fibrin‐coated collagen patch to reduce the risk of postoperative POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Schindl

Függer

Götzinger

et al. 2018

British Journal of Surgery

View full text Add to dashboard Cite

BackgroundThe potential for a fibrin sealant patch to reduce the risk of postoperative pancreatic fistula (POPF) remains uncertain. The aim of this study was to evaluate whether a fibrin sealant patch is able to reduce POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy.MethodsIn this multicentre trial, patients undergoing pancreatoduodenectomy were randomized to receive either a fibrin patch (patch group) or no patch (control group), and stratified by gland texture, pancreatic duct size and neoadjuvant treatment. The primary endpoint was POPF. Secondary endpoints included complications, drain‐related factors and duration of hospital stay. Risk factors for POPF were identified by logistic regression analysis.ResultsA total of 142 patients were enrolled. Forty‐five of 71 patients (63 per cent) in the patch group and 40 of 71 (56 per cent) in the control group developed biochemical leakage or POPF (P = 0·392). Fistulas were classified as grade B or C in 16 (23 per cent) and ten (14 per cent) patients respectively (P = 0·277). There were no differences in postoperative complications (54 patients in patch group and 50 in control group; P = 0·839), drain amylase concentration (P = 0·494), time until drain removal (mean(s.d.) 11·6(1·0) versus 13·3(1·3) days; P = 0·613), fistula closure (17·6(2·2) versus 16·5(2·1) days; P = 0·740) and duration of hospital stay (22·1(2·2) versus 18·2(0·9) days; P = 0·810) between the two groups. Multivariable logistic regression analysis confirmed that obesity (odds ratio (OR) 5·28, 95 per cent c.i. 1·20 to 23·18; P = 0·027), soft gland texture (OR 9·86, 3·41 to 28·54; P < 0·001) and a small duct (OR 5·50, 1·84 to 16·44; P = 0·002) were significant risk factors for POPF. A patch did not reduce the incidence of POPF in patients at higher risk.ConclusionThe use of a fibrin sealant patch did not reduce the occurrence of POPF and complications after pancreatoduodenectomy with pancreatojejunostomy. Registration number: 2013‐000639‐29 (EudraCT register).

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Schindl

Függer

Götzinger

et al. 2018

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Similarly, reported mortality (range, 0.2-0.4%) (9,18) and reoperation rates (range, 2.1-6.0%) (18,24,25) (26)(27)(28)(29)(30). Spleen preserving LDP has been described to be safe and feasible (10,22) and has been reported in 18.2% (16) to 60.4% (31) of LDPs.…”

Section: Distal Pancreatectomy (Dp)mentioning

confidence: 87%

Laparoscopic pancreatic resection—a review

Justin

Fingerhut²,

Khatkov³

et al. 2016

Transl. Gastroenterol. Hepatol.

View full text Add to dashboard Cite

show abstract

“…In our experiments, they dissolved within hours in pancreatic juice. This explained results from clinical meta‐analyses that show no clinical benefit for the application of fibrin‐based sealants .…”

Section: Discussionmentioning

confidence: 99%

“…Most products are used off‐label and many surgeons do not take into consideration that pancreatic digestive enzymes released from the pancreas are likely to possess proteolytic activity to some degree. Thus, it comes as no surprise that fibrin glue does not reduce POPF in most clinical studies as well as systematic reviews . To avoid the weakness of compounds susceptible to proteolysis, non‐absorbable compounds such as acrylamide have been applied as well.…”

Section: Introductionmentioning

confidence: 99%

Bio‐absorbable sealants for reinforcing the pancreatic stump after distal pancreatectomy are critical

Kühlbrey

Kasper

Chikhladze

et al. 2019

J Hepato Biliary Pancreat

View full text Add to dashboard Cite

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.

show abstract

Systematic review on the use of matrix bound sealants in pancreatic resection

Abstract: The present data do not support the routine use of matrix-bound sealants after a pancreatic resection, as there was no effect on clinically relevant POPF. Larger, well-designed studies are needed to determine the efficacy of sealants in preventing POPF after a pancreatoduodenectomy.

Cited by 16 publications

References 31 publications

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy

Laparoscopic pancreatic resection—a review

Bio‐absorbable sealants for reinforcing the pancreatic stump after distal pancreatectomy are critical

Contact Info

Product

Resources

About