Pancreaticojejunostomy using a fibrin adhesive sealant (TachoComb) for the prevention of pancreatic fistula after pancreaticoduodenectomy.

BACKGROUND/AIMS: Pancreatic fistula is a common complication following pancreaticoduodenectomy. A number of technical modifications aimed to improve the pancreato-enteric anastomosis technique have been reported. The aim of this study was to evaluate the safety of TachoComb fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy after pancreaticoduodenectomy.

METHODOLOGY: Between 2005 to 2009, 40 patients (28 men and 12 women) underwent duct-to-mucosa pancreaticojejunostomy using a fibrin adhesive (TachoComb) sealing method after pancreaticoduodenectomy (either pylorus-preserving or modified Child's methods). The mean age was 67.9 years (range of 49 to 80 years).

RESULTS

The overall postoperative rates of mortality and morbidity were 0.0% and 35.0%, respectively. Following the classification system described by the International Study Group on Pancreatic Fistula, 5 patients (12.5%) had Grade A pancreatic fistulas and 3 patients (7.5%) had Grade B pancreatic fistulas. There were no patients with Grade C pancreatic fistulas, and no cases of postoperative hemorrhage. No significant difference in the length of postoperative hospital stay was observed in patients with or without pancreatic fistulas.

CONCLUSIONS

The use of TachoComb fibrin adhesive as a sealing method in duct-to-mucosa pancreaticojejunostomy is safe, reliable for the prevention of pancreatic fistula, and shows promise for all types of reconstruction following pancreaticoduodenectomy.