Interaction between pancreatic fluid and three different hemostatic agents: an in-vitro study
Volkan Oter1, Kerem Karaman1, Ali Bal2, Mehmet Aziret1, Metin Ercan1, Erdal Birol Bostanci3
1Sakarya University Faculty of Medicine, Department of Gastroenterological Surgery, Sakarya, Turkey
2Sakarya University Faculty of Medicine, Department of Surgical Oncology, Sakarya, Turkey
3SBU Turkiye Yuksek İhtisas Training and Research Hospital, Department of Gastroenterology Surgery, Ankara, Turkey
Aim: Although recent developments in surgery led to mortality reduction under 2%, postoperative pancreatic fistula (POPF) remains high reported from 20% up to 40%. Primary aim of the present in-vitro study was to determine the interaction between pancreatic fluid and three different hemostatic agents.
Material and methods: Three different hemostatic agent; fibrin sealant Tisseel, Floseal and Ankaferd Blood Stopper (ABS) were mixed in tubes with pancreatic fluid in equal proportions. The length of the gel aggregate of each sample which covers the pancreatic fluid in the tube was measured as mm and thereafter statistically compared.
Results: Tisseel significantly formed an intensely thicker gel than Floseal and ABS (Tisseel vs FloSeal; P<0.0001, Tisseel vs ABS; P<0.0001). Further, the thickness of the gel formation was significantly higher in FloSeal-pancreatic fluid mixture than the ABS-pancreatic fluid mixture (P<0.0001). Under light microscope, Tisseel formed a much more homogenous and dens mixture than Floseal and ABS.
Conclusion: Tisseel fibrin sealant has beneath its hemostatic properties also the potential of preventing pancreatic fistula development. Further in-vitro and in-vivo studies are needed to reach a definitive conclusion.