TachoSil® for prevention of postpancreatectomy hemorrhage after distal pancreatectomy: a propensity-weighted pilot study.

PURPOSE: Postpancreatectomy hemorrhage (PPH) is a rare but potentially lethal complication after distal pancreatectomy (DP), often precipitated by clinically relevant postoperative pancreatic fistula (POPF). While the fibrin sealant patch TachoSil® has been evaluated for POPF prevention, its role in mitigating PPH remains underexplored. METHODS: We conducted a single-center, retrospective cohort study of consecutive adult patients undergoing DP (2015–2024). Patients were classified by intraoperative use of TachoSil® in addition to standard stump closure. The primary endpoint was PPH, defined per International Study Group of Pancreatic Surgery (ISGPS) criteria. Secondary endpoints included clinically relevant POPF, Comprehensive Complication Index (CCI), reoperation, 90-day mortality, and length of stay (LOS). Inverse probability of treatment weighting (IPTW) was applied to adjust for baseline covariates. RESULTS: Of 224 patients, 56 (25%) received TachoSil®. After IPTW adjustment, TachoSil® was associated with a reduced risk of PPH (RD − 0.065; 95% CI − 0.121 to − 0.009; p = 0.014), corresponding to a number needed to treat (NNT) of 15 and an E-value of 6.7. No significant differences were observed for clinically relevant POPF (RD 0.116; p = 0.105), CCI (MD 3.459; p = 0.091), reoperation (RD − 0.016; p = 0.486), 90-day mortality (RD 0.012; p = 0.498), or LOS (MD − 0.242 days; p = 0.856). Stratified analysis showed a pronounced reduction in PPH among patients who developed POPF (RD − 0.180; 95% CI − 0.311 to − 0.048; p = 0.004; NNT = 6; E-value = 12.6), while no significant effect was observed in patients without POPF. CONCLUSIONS: TachoSil® use after DP was not associated with lower POPF rates but significantly reduced PPH incidence, particularly in patients developing POPF. These findings support selective TachoSil® application in high-risk patients as part of a targeted strategy to prevent severe hemorrhagic complications after DP.