Pancreatic duct occlusion with acrylic glue after pancreas resection.

UNLABELLED: Postoperative complications following major pancreatic surgery are mainly due to the difficulties of performing a safe and proper anastomosis between the stomach or small bowel and the rest of the pancreas. We cannot influence the main predisposing factor of pancreatic fistula--soft pancreatic parenchyma, but we can decrease or completely block postoperative pancreatic secretion. In the last 5 years we performed 61 major pancreatic resections. There were 49 men, mean age 63 years (range 31-78) and 12 women, mean age 57 years (range 45-75). The occlusion of the main pancreatic duct was performed in 33 patients with cyanoacrylate manomer indermil (Sherwood, Davies Geck) after pancreatic resection with different types of anastomosis of their pancreatic stump. Fistula developed where glue was used only in 1 case out of 33 patients (1/33-3%) compared with 28 patients where glue was not used--fistula developed in 9 cases (9/28-32%). The difference is highly significant (p < 0.05). Only 1 out of 10 patients with pancreatic fistulation was operated later on; in 9 cases fistula closed spontaneously. Fistulo-jejunoanastomosis was performed in this patient with chronic torpid fistulation. No postoperative pancreatitis developed after blind closure of pancreatic stump.

IN CONCLUSION: any decrease of pancreatic secretion from the rest of the pancreas after duodenopancreatectomy can significantly reduce the development of postoperative pancreatic fistula which can have a catastrophic influence on surgery outcome. Using glue in the pancreatic main duct is not only safe but can be an effective simple procedure in any type of pancreatic stump treatment.