Die Pankreaslinksresektion mit autologem Fibrinkleber – Anwendung eines etablierten Versiegelungskonzepts in der Pankreaschirurgie

Zusammenfassung

Hintergrund: Die postoperative Pankreasfistel nach Pankreaslinksresektion ist bis heute ein ungelöstes Problem, denn unabhängig von der Verschlusstechnik entwickeln etwa 30 % der Patienten nach einer Pankreaslinksresektion eine Pankreasfistel. Erstmals wurde bei Pankreaslinksresektionen autologes Fibrin (Vivostat®) zum additiven Abdichten des Pankreasabsetzungsrands verwendet. Ziel war es, zu untersuchen, ob ein verändertes postoperatives Ergebnis vorliegt.

Patienten/Material und Methoden: Im Jahr 2015 wurde eine technische Fallserie bei 15 Patienten durchgeführt. Im Rahmen von Pankreaslinksresektionen wurde autologer Fibrinkleber auf den Pankreasabsetzungsrand appliziert.

Ergebnisse: Bei 5/15 Patienten (33 %) trat eine Pankreasfistel auf. In einem Fall trat eine Grad-A-Fistel auf (1/15, 6,7 %), während eine Grad-B-Fistel in 4/15 Fällen (26,7 %) vorlag. Bei 75 % (3/4) der Patienten mit einer Grad-B-Fistel war eine Antibiotikatherapie ausreichend. Nur bei einem Patienten war postoperativ eine CT-gesteuerte Drainagenanlage erforderlich.

Schlussfolgerung: Autologer Fibrinkleber ist unkompliziert anzuwenden und scheint gut verträglich. Postoperative Pankreasfisteln nach Pankreaslinksresektionen scheinen sich dadurch allerdings nicht vermeiden zu lassen.

Abstract

Background: Postoperative pancreatic fistulas (POPF) remain a major concern after distal pancreatectomy. Irrespective of the technique to close the pancreatic remnant, pancreatic fistulas will occur in approximately 30 % of patients undergoing distal pancreatectomy. For the first time ever, autologous fibrin sealant (Vivostat®) was used to additionally seal the pancreatic remnant after a distal pancreatectomy. The aim was to analyse whether this changes the postoperative outcome.

Patients/Material and Methods: In 2015, a technical case series was performed in 15 patients who underwent distal pancreatectomy. The pancreatic remnant was additionally sealed with autologous fibrin sealant (Vivostat®).

Results: A postoperative pancreatic fistula (POPF) occurred in 5/15 patients (33 %). One patient had a POPF grade A (1/15, 6.7 %), whereas a POPF grade B occurred in 4/15 patients (26.7 %). 75 % (3/4) of the patients with a POPF grade B were sufficiently treated with antibiotics, whereas a CT-guided percutaneous drainage had to be placed only in one case.

Conclusion: Autologous fibrin sealant is simple to apply and seems to be well tolerated. However, it does not seem to avoid the development of postoperative pancreatic fistulas after distal pancreatectomy.

Schlüsselwörter

Pankreaslinksresektion - Pankreasfistel - autologer Fibrinkleber - Vivostat - Pankreasoperation

Key words

pancreatic fistula - autologous fibrin sealant - Vivostat - distal pancreatectomy - pancreatic surgery

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