Human fibrinogen patches application reduces intra-abdominal infectious complications in pancreas transplant with enteric drainage

World J Surg. 2010 Dec;34(12):2991-6. doi: 10.1007/s00268-010-0774-z.

Abstract

Purpose: The purpose of the study was to analyze the incidence of intra-abdominal infectious complications after the application of a fibrinogen sealant to the duodenojejunal anastomosis in simultaneous pancreas-kidney transplants (SPK) with enteric drainage.

Methods: Results of 68 SPKs with enteric drainage were prospectively assessed. A fibrinogen and thrombin sheet was applied to the duodenojejunal anastomosis in 34 patients, who were compared to a control group of 34 patients. The incidence and severity of intra-abdominal infectious complications and the 1-year patient and grafts survival were analyzed.

Results: Eighteen patients experienced intra-abdominal infectious complications. Grade 1a complications occurred in the study group, whereas surgery was required only in patients from the control group: complications grade 3a (15%) and complications grade 3b (18%) (p = 0.003 vs. study group, respectively). The overall rate of anastomotic leakage (complications grade 2b and 3b) was 10%, all of which occurred in the control group. The length of hospital stay was higher in the control group was 34.6 ± 11.3 days vs. 22.8 ± 11.1 days (p = 0.03). There were no significant differences in 1-year patient and graft survival between groups.

Conclusions: In our study, the application of fibrinogen and thrombin sheets was associated to a decrease in the number and severity of intra-abdominal infectious complications.

Publication types

  • Clinical Trial

MeSH terms

  • Abdominal Cavity
  • Administration, Topical
  • Adult
  • Anastomosis, Surgical / adverse effects*
  • Anastomotic Leak / epidemiology
  • Anastomotic Leak / etiology
  • Anastomotic Leak / prevention & control*
  • Bacterial Infections / epidemiology
  • Bacterial Infections / etiology
  • Bacterial Infections / prevention & control*
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / surgery
  • Drainage
  • Duodenum / surgery
  • Female
  • Fibrinogen / administration & dosage*
  • Humans
  • Incidence
  • Jejunum / surgery
  • Kidney Transplantation / adverse effects
  • Male
  • Middle Aged
  • Pancreas Transplantation / adverse effects*
  • Prospective Studies
  • Renal Insufficiency / etiology
  • Renal Insufficiency / surgery
  • Thrombin / administration & dosage
  • Tissue Adhesives / administration & dosage*

Substances

  • Tissue Adhesives
  • Fibrinogen
  • Thrombin