Reduction in Post-operative Pancreatic Fistula with Polyethylene Glycol and Recombinant Human Albumin Sealant Following Stapled Distal Pancreatectomy

Abstract

Purpose: Postoperative pancreatic fistula (POPF) remains a significant cause of morbidity in patients undergoing distal pancreatectomy (DP). Various methods of treating the remnant pancreas have been evaluated however few have shown significant reductions in POPF rates. The aim of this study is to assess if the use of polyethylene glycol (PEG) sealant gel applied to the transected pancreatic margin in DP reduces POPF rates. Method: A retrospective single centre cohort study of patients undergoing DP at an Australian high volume tertiary institution between January 2015 and January 2021. A historical control group was compared with an intervention group (PEG group) managed with a standard technique. Pancreatic transection performed with a non-reinforced Endo GIATM Black 60 mm tri-stapler (4.0mm – 5.0mm). Following transection, 4 ml of a polyethelene glycol-based adhesive, mixed with human albumin (ProgelTM) was applied to the staple line. Results: 54 cases were identified for analysis, with 16 patients in the PEG group. The majority of the control group had stapled DP 92% (35 of 38), with approximately half 47% (18 of 38) combined with a reinforcing buttress, with or without the use other glue types. 28 of 54 (52%) developed a POPF, with a significantly lower rate in the PEG group (3 of 16 vs. 25 of 38 in the Control group; P = 0.003). Clinically significant Grade B/C POPF was lower in the PEG group (0 of 16 vs. 9 of 28 in the Control group; P = 0.045. Patients in the PEG group had a shorter median (interquartile range) length of hospital stay (6 [4–14] days versus 10 [6–41] days P = 0.04). Conclusion: The reduction in clinically significant POPF in the PEG group is extremely promising and warrants further prospective assessment and validation. An investigator led multicentre randomised controlled trial using PEG in the setting of stapled distal pancreatectomy is currently underway to validate the findings of this study.