Metin ERCAN, Mehmet AZİRET, Ali BAL, Kerem KARAMAN, Erdal Birol BOSTANCİ, Volkan OTER

Interaction between pancreatic fluid and three different hemostatic agents: An in-vitro study

Aim: Although recent developments in surgery led to mortality reduction under 2%, postoperative pancreatic fistula (POPF) remains high reported from 20% up to 40%. Primary aim of the present in-vitro study was to determine the interaction between pancreatic fluid and three different hemostatic agents.Material and methods: Three different hemostatic agent; fibrin sealant Tisseel, Floseal and Ankaferd Blood Stopper (ABS) were mixed in tubes with pancreatic fluid in equal proportions. The length of the gel aggregate of each sample which covers the pancreatic fluid in the tube was measured as mm and thereafter statistically compared.Results: Tisseel significantly formed an intensely thicker gel than Floseal and ABS (Tisseel vs FloSeal; P

PDF

___

1. Bassi C, Dervenis C, Butturini G. et al; International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138: 8-13.
2. Roberts KJ, Sutcliffe RP, Marudanayagam R, et al. Scoring System to Predict Pancreatic Fistula After Pancreaticoduodenectomy: A UK Multicenter Study. Ann Surg 2015;261:1191-7.
3. Justin V, Fingerhut A, Khatkov I, et al. Laparoscopic pancreatic resection-a review. Transl Gastroenterol Hepatol 2016;1:36.
4. Thaker RI, Matthews BD, Linehan DC, et al. Absorbable mesh reinforcement of a stapled pancreatic transection line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg 2007;11:59-65.
5. Kuroki T, Tajima Y, Tsuneoka N, et al. Gastric wall-covering method prevents pancreatic fistula after distal pancreatectomy. Hepatogastroenterol 2009;56:877-80.
6. Walters DM, Stokes JB, Adams RB, et al. Use of a falciform ligament pedicle flap to decrease pancreatic fistula after distal pancreatectomy. Pancreas 2011;40:595 -9.
7. Goh BK, Tan YM, Chung YF, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg 2008;143:956-65.
8. Okabayashi T, Hanazaki K, Nishimori I, et al. Pancreatic transection using a sharp hook-shaped ultrasonically activated scalpel. Langenbecks. Arch Surg 2008;393:1005-8.
9. Probst P, Hüttner FJ, Klaiber U, et al. Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy. Cochrane Database Syst Rev 2015;11:CD008688.
10. Michalski CW, Tramelli P, Büchler MW, et al. Closure of pancreas stump after distal and segmental resection: Suture, stapler, coverage or anastomosis? Chirurg 2017;88:25-9.
11. Fahy BN, Frey CF, Ho HS, et al. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002;183:237-41.
12. Liu QY, Zhang WZ, Xia HT, et al. Analysis of risk factors for postoperative pancreatic fistula following pancreaticoduodenectomy. World J Gastroenterol 2014;20:17491-7.
13. Fu SJ, Shen SL, Li SQ, et al. Risk factors and outcomes of postoperative pancreatic fistula after pancreatico-duodenectomy: an audit of 532 consecutive cases. BMC Surg 2015;15:34.
14. Sandini M, Malleo G, Gianotti L. Scores for Prediction of Fistula after Pancreatoduodenectomy: A Systematic Review. Dig Surg 2016;33:392-400.
15. Hanna EM, Martinie JB, Swan RZ, et al. Fibrin sealants and topical agents in hepatobiliary and pancreatic surgery: a critical appraisal. Langenbecks. Arch Surg 2014;399:825-35.
16. Weniger M, D’Haese JG, Crispin A, et al. Autologous but not fibrin sealant patches for stump coverage reduce clinically relevant pancreatic fistula in distal pancreatectomy: a systematic review and meta-analysis. World J Surg 2016;40:2771-81.
17. Akita H, Takahashi H, Gotoh K, et al. Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue. Langenbecks. Arch Surg 2015;400: 843-8.
18. Kollár D, Huszár T, Pohárnok Z, et al. A Review of techniques for closure of the pancreatic remnant following distal pancreatectomy. Dig Surg 2016;33:320-8.
19. Jang JY, Shin YC, Han Y, et al. Effect of polyglycolic acid mesh for prevention of pancreatic fistula following distal pancreatectomy: a randomized clinical trial. JAMA Surg 2017;152:150-5.
20. Steer ML. Exocrine pancreas. SABİSTON, Text Book of Surgery, 18th Edition 2008;1589-623.
21. Musella M, Milone M, Maietta P, et al. Laparoscopic sleeve gastrectomy: efficacy of fibrin sealant in reducing postoperative bleeding. A randomized controlled trial. Updates Surg 2014; 66:197-201.
22. Coskun H, Yardimci E. Effects and results of fibrin sealant use in 1000 laparoscopic sleeve gastrectomy cases. Surg Endosc 2017;31:2174-9.
23. Bonanomi G, Prince JM, McSteen F, et al. Sealing effect of fibrin glue on the healing of gastrointestinal anastomoses: implications for the endoscopic treatment of leaks. Surg Endosc 2004;18:1620-4.
24. Vakalopoulos KA, Daams F, Wu Z, et al. Tissue adhesives in gastrointestinal anastomosis: a systematic review. Surg Res 2013 Apr;180(2):290-300.
25. Echave M, Oyagüez I, Casado MA. Use of Floseal®, a human gelatine-thrombin matrix sealant, in surgery: a systematic review. BMC Surg 2014;14:111.
26. Goker H, Haznedaroglu IC, Ercetin S, et al. Haemostatic actions of the folkloric medicinal plant extract, ABS. J Int Med Res 2008;36:163-70.
27. Bilgili H, Kosar A, Kurt M, et al. Hemostatic efficacy of Ankaferd Blood Stopper in a swine bleeding model. Med Princ Pract 2009;18:165-9.
28. Cipil HS, Kosar A, Kaya A, et al. In vivo hemostatic effect of the medicinal plant extract Ankaferd Blood Stopper in rats pretreated with warfarin. Clin Appl Thromb Hemost 2009;15:270-6.
29. Karaman K, Celep B, Bostanci EB, et al. Effects of Ankaferd Blood Stopper on pancreatic fluid: An in vitro study. ANZ J Surg 2010;80:946-7.
30. Karaman K, Bostanci EB, Celep B, et al. In Vivo Healing Effects of Ankaferd Blood Stopper on the Residual Pancreatic Tissue in a Swine Model of Distal Pancreatectomy. Indian J Surg 2015;77:176-81.