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Effectiveness of Tachosil® in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis

  • SYSTEMATIC REVIEW AND META-ANALYSIS
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

Postoperative pancreatic fistula (POPF) is a frequent and clinically relevant problem after distal pancreatectomy. A variety of methods have been tested in the attempt to prevent POPF, most of them without convincing results.

Methods

A systematic literature search was conducted in PubMed, Embase and the Cochrane Library to identify clinical studies comparing pancreatic stump closure with the addition of Tachosil® to conventional stump closure. The identified studies were critically appraised, and meta-analyses were performed using a random-effects model. Dichotomous data were pooled using odds ratios, and weighted mean differences were calculated for continuous outcomes, together with the corresponding 95 % confidence intervals.

Results

Four studies (two randomised controlled trials and two retrospective clinical studies) reporting data from 738 patients were included in the meta-analysis. Overall POPF, clinically-relevant POPF, mortality, reoperations, intraoperative blood loss and length of hospital stay did not differ significantly between conventional closure and additional covering of the pancreatic stump with Tachosil®. A sensitivity analysis of only randomised controlled trials confirmed the results.

Conclusions

The application of Tachosil® to the pancreatic stump after distal pancreatectomy is a safe procedure but provides no relevant benefit in terms of POPF, mortality, reoperation rate, blood loss or length of hospital stay. Future research should concentrate on novel methods of pancreatic stump closure to prevent POPF after distal pancreatectomy.

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Authors’ contributions

Study conception and design: F. J. Hüttner, A. L. Mihaljevic, M. K. Diener and M. W. Büchler

Acquisition of data: F. J. Hüttner, A. L. Mihaljevic and M. K. Diener

Analysis and interpretation of data: F. J. Hüttner, A. L. Mihaljevic, T. Hackert, A. Ulrich, M. K. Diener and M. W. Büchler

Drafting of manuscript: F. J. Hüttner, A. L. Mihaljevic and M. K. Diener

Critical revision of manuscript: T. Hackert, A. Ulrich and M. W. Büchler

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Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Felix J. Hüttner, André L. Mihaljevic, Thilo Hackert, Alexis Ulrich, Markus W. Büchler & Markus K. Diener

  2. Study Center of the German Surgical Society, University of Heidelberg, Heidelberg, Germany

    Felix J. Hüttner & Markus K. Diener

Authors
  1. Felix J. Hüttner
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  2. André L. Mihaljevic
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  3. Thilo Hackert
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  4. Alexis Ulrich
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  5. Markus W. Büchler
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  6. Markus K. Diener
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Corresponding author

Correspondence to Markus W. Büchler.

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Funding

The Study Centre of the German Surgical Society was funded by grant 01GH0702 from the BMBF (Federal Ministry of Education and Research, Germany) up to 31 December 2013. The Systematic Reviews Working Group received a donation from Covidien. No direct funding was received for this study.

Conflicts of interest

None.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For a systematic review and meta-analysis, no formal informed consent is required. However, as stated in the individual reports of the underlying studies, informed consent was obtained from all individual participants included in the underlying studies.

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Hüttner, F.J., Mihaljevic, A.L., Hackert, T. et al. Effectiveness of Tachosil® in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis. Langenbecks Arch Surg 401, 151–159 (2016). https://doi.org/10.1007/s00423-016-1382-7

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  • DOI: https://doi.org/10.1007/s00423-016-1382-7

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