Despite substantial improvements in perioperative mortality, complications, and specifically the development of a
pancreatic fistula, remain a common occurrence after
pancreaticoduodenectomy. It was the objective of this study to evaluate the role of
fibrin glue sealant as an adjunct to decrease the rate of
pancreatic fistula after
pancreaticoduodenectomy. One hundred twenty-five patients were randomized after pancreaticoduodenal resection only if, in the opinion of the surgeon, the pancreaticojejunal anastomosis was at high risk for development of a pancreatic
anastomotic leak. After completion of the pancreaticojejunal anastomosis, the patients were randomized to topical application of
fibrin glue sealant to the surface of the anastomosis or no such application. The primary postoperative end points in this study were
pancreatic fistula, total complications, death, and length of
hospital stay. A total of 59 patients were randomized to the
fibrin glue arm, whereas 66 patients were randomized to the control arm and did not receive
fibrin glue application. The
pancreatic fistula rate in the
fibrin glue arm of the study was 26% vs. 30% in the control group (p = not significant [NS]). The mean length of postoperative stay for all patients randomized was similar (
fibrin glue = 12.2 days, control = 13.6 days) and the mean
length of stay for patients in whom
pancreatic fistula developed was also not different (
fibrin glue = 18.9 days, control = 21.7 days). There were no differences with respect to total complications or specific complications such as postoperative
bleeding,
infection, or delayed gastric emptying. These data demonstrate that the topical application of
fibrin glue sealant to the surface of the pancreatic anastomosis in this patient population undergoing high-risk pancreaticojejunal anastomosis did not reduce the incidence of
pancreatic fistula or total complications after pancreaticodudodenectomy. There seems to be no benefit regarding the use of this substance in this setting.