Topically applied 2-octyl cyanoacrylate (Dermabond) for prevention of postoperative pancreatic fistula after pancreaticoduodenectomy

J Gastrointest Surg. 2012 Aug;16(8):1499-507. doi: 10.1007/s11605-012-1908-4. Epub 2012 May 12.

Abstract

Objective: We examined whether 2-octyl cyanoacrylate (Dermabond) topically applied to the pancreaticojejunostomy (PJ) anastomotic site after pancreaticoduodenectomy (PD) reduces the rate of postoperative pancreatic fistula (POPF).

Methods: Patients who underwent PD with duct-to-mucosa PJ were evaluated (n = 124). Outcome was compared between patients who received Dermabond (n = 75) after PD and historic patients who did not (n = 49). Risk factors for POPF were identified.

Results: Overall and clinically relevant rates of POPF were significantly lower in patients who received Dermabond than in patients who did not (2.6 % and 1.3 % vs. 22 % and 12 %, respectively; p = 0.001). In univariate analysis, pancreatic duct diameter ≤3 mm, low serum albumin level, and no Dermabond were independent risk factors for POPF; in multivariate analysis, no Dermabond was an independent risk factor for POPF. In patients with pancreatic duct diameter ≤3 mm, the rate of POPF was significantly lower in patients who received Dermabond than in patients who did not (3.5 % versus 36 %, respectively; p = 0.0001). Patients who received Dermabond had significantly shorter hospital stays and lower re-operation and re-admission rates.

Conclusions: Topical application of Dermabond to the PJ anastomotic site after PD significantly reduced the rate of POPF, particularly in patients at risk.

Publication types

  • Clinical Trial

MeSH terms

  • Administration, Topical
  • Aged
  • Cyanoacrylates / therapeutic use*
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Pancreatic Fistula / epidemiology
  • Pancreatic Fistula / etiology
  • Pancreatic Fistula / prevention & control*
  • Pancreaticoduodenectomy*
  • Pancreaticojejunostomy / methods*
  • Patient Readmission / statistics & numerical data
  • Pilot Projects
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Reoperation / statistics & numerical data
  • Risk Factors
  • Tissue Adhesives / therapeutic use*
  • Treatment Outcome

Substances

  • Cyanoacrylates
  • Tissue Adhesives
  • octyl 2-cyanoacrylate