Systematic review on the use of matrix-bound sealants in pancreatic resection

BackgroundPancreatic fistula is a potentially life-threatening complication after a pancreatic resection. The aim of this systematic review was to evaluate the role of matrix-bound sealants after a pancreatic resection interms of preventing or ameliorating the course of a post-operative pancreatic fistula. MethodsA systematic search was performed in the literature from May 2005 to April 2015. Included were clinical studies using matrix-bound sealants after a pancreatic resection, reporting a post-operative pancreatic fistula (POPF) according to the International Study Group on Pancreatic Fistula classification, in which grade B and C fistulae were considered clinically relevant. ResultsTwo were studies on patients undergoing pancreatoduodenectomy (sealants n=67, controls n=27) and four studies on a distal pancreatectomy (sealants n=258, controls n=178). After a pancreatoduodenectomy, 13% of patients treated with sealants versus 11% of patients without sealants developed a POPF (P=0.76), of which 4% versus 4% were clinically relevant (P=0.87). After a distal pancreatectomy, 42% of patients treated with sealants versus 52% of patients without sealants developed a POPF (P=0.03). Of these, 9% versus 12% were clinically relevant (P=0.19). ConclusionsThe present data do not support the routine use of matrix-bound sealants after a pancreatic resection, as there was no effect on clinically relevant POPF. Larger, well-designed studies are needed to determine the efficacy of sealants in preventing POPF after a pancreatoduodenectomy.