Pancreatic Duct Occlusion with Fibrin Sealant for the Protection of Pancreatic-Digestive Anastomoses Following Resection of the Pancreatic Head: Experimental and Clinical Study

Abstract

The tissue-specific nature of the pancreas parenchyma — especially its tryptic activity — causes high complication and mortality rates following pancreas resections. The pancreatic-digestive anastomosis is especially endangered by dehiscence when a healthy lienal pancreatic rest is to be connected with the intestine after resections for carcinoma, but it is also seen after segmental pancreas transplantations. Therefore this anastomosis is called the “weak point” of Whipple’s operation (partial duo-denopancreatectomy). In the literature, the incidence of postoperative insufficiencies and pancreatic fistulae following pancreaticojejunostomy is reported to be 5%–35%. The average mortality after partial duodenopancreatectomies is approximately 14% (1.3%–36.3%) [4, 17, 20]. Previously, to avoid these complications many surgeons extended this intervention in cases of ductal pancreatic carcinoma and chronic pancreatitis to a total duodenopancreatectomy. However, the risk of a hardly adjustable postoperative diabetes had to be accepted. Presently the total duodenopancreatectomy represents only a makeshift solution [7].