Use of Sealants in Pancreatic Surgery: Critical Appraisal of the Literature

Abstract

Background/Aims: Fibrin sealants containing both fibrin and thrombin have been used to control bleeding, reinforce suture lines and enhance tissue healing. However, the literature provides contradictory results. Methods: A systematic literature search was performed to determine the use of fibrin sealants in pancreatic surgery. These articles were then critically appraised according to their methodologies, outcomes and conclusions. Results: Twenty-four studies were found, including 6 controlled randomized trials. Of these, 16 studies were analyzed. Many methodological flaws and lack of consistency in definitions were found, making comparisons between studies difficult if not impossible. Conclusion: Because of the heterogeneity and lack of high-level evidence, the current literature does not allow us any conclusion: neither is there proof that fibrin sealants are of any real utility in pancreatic surgery, nor that they do not work. Further large-scale controlled trials are necessary before concluding that they do or do not provide any advantages in pancreatic surgery.

Laparoscopic Distal Pancreatectomy with or Without Splenectomy: How I Do It

“…Several studies have shown the use of Tisseel fibrin sealant (Baxter Pharmaceuticals, Deerfield, IL, USA) injected into the duct or over the pancreatic staple line, though not harmful, demonstrated no significant decrease in the rate of fistula formation. 15 Meticulous dissection and oversewing of the pancreatic duct remain the gold standard for optimal outcome to minimize pancreatic leak.…”

Blunt trauma pancreas

“…No method has proven superior for preventing postoperative fistulas or leaks. 19,20 Preservation of the pancreatic tail must be attempted in patients with injury to the right of the mesenteric vessels, where complete resection can lead to endocrine compromise in up to 50% of patients.…”

Uso de adesivos teciduais em cirurgia digestiva

“…Aplicações em cirurgia gastroenterológica incluem: prevenção de aderências peritoneais, cirurgia esplênica, hepatectomias, prevenção e tratamento de fístulas pancreáticas, enterocutâneas e anais 2,10,11,14,23 .…”

“…Têm sido utilizados em complicações de anastomoses pancreáticas com resultados satisfatórios. Entretanto, metanálise sobre o uso destes adesivos em cirurgia pancreática mostraram-se inconclusivos em decorrência da heterogeneidade e falta de evidência à sua utilização 10,16 .…”