Evidence news! An updated Cochrane review has been published investigating “Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery”.
Objective: To evaluate the benefits and harms of using fibrin sealant versus no fibrin sealant to prevent postoperative pancreatic fistula (grade B or C) in people undergoing pancreatic surgery.
Main results: 14 randomised controlled trials (RCTs) with 1,989 participants were included. This updated review has added two new RCTs and includes rigorously conducted meta-analyses with outcomes ranging from low to very low certainty of evidence.
The review categorized the studies into three groups due to different pancreatic operations with varying sealant applications:
- Fibrin sealants to pancreatic stump closure reinforcement after distal pancreatectomy
- Fibrin sealants to pancreatic anastomosis reinforcement after pancreaticoduodenectomy
- Fibrin sealants to pancreatic duct occlusion after pancreaticoduodenectomy
Pancreatic fistula (grade B or C) within 30 days
- Group 1: Fibrin sealants may result in little to no difference in the rate of pancreatic fistula, with an anticipated risk of 199 per 1,000 patients (95% CI 155–256) receiving fibrin sealant versus 212 per 1,000 patients without any sealant use
- Group 2: The evidence is very uncertain about the effect of fibrin sealant on the rate of pancreatic fistula, with an anticipated risk of 130 per 1,000 patients (95% CI 70–240) receiving fibrin sealant versus 97 per 1,000 patients without any sealant use
- Group 3: No available data
Reoperation rate within 30 days
- Group 1: Fibrin sealant use may reduce the reoperation rate slightly, with an anticipated risk of 25 per 1,000 patients (95% CI 11–56) receiving fibrin sealant versus 62 per 1,000 patients without any sealant use
- Group 2 and 3: The evidence is very uncertain about the effect of fibrin sealant use
Postoperative mortality and morbidity within 30 days
- All groups: there seems to be no evidence of a difference between fibrin sealant use and no fibrin sealant use for these outcomes
Authors' conclusion: The authors concluded that fibrin sealant use may result in little to no difference in the rate of postoperative pancreatic fistula in people undergoing distal pancreatectomy. The evidence is very uncertain about the effect of fibrin sealant use on the rate of pancreatic fistula in people undergoing pancreaticoduodenectomy. The effect of fibrin sealant use on postoperative mortality is also uncertain in people undergoing either distal pancreatectomy or pancreaticoduodenectomy.
Access publication: https://doi.org/10.1002/14651858.CD009621.pub5
