Influence on Postoperative Results and Cost-effectiveness of Using Cyanoacrylate Glue for Pancreaticojejunal Anastomosis After Duodenopancreatectomy.

Abstract

Introduction: Postoperative pancreatic fistula (POPF) remains the most serious complication of pancreatoduodenectomy (PD), which justifies the search for alternatives to reinforce pancreaticojejunal anastomosis (PJA).

Objective: To evaluate the effect on postoperative results and on the cost-effectiveness of using synthetic cyanoacrylate glue in PJA after PD.

Methods: Prospective, randomized study, including 63 consecutive patients undergoing PD divided into 2 groups: GWC (group with cyanoacrylate), 30 patients using synthetic cyanoacrylate glue in the PJA, and 33 patients without application (GWOC, group without cyanoacrylate). The variables studied were organized in epidemiological, clinical, and laboratory terms, with emphasis on the incidence of pancreatic fistula, grouped according to the definition of the International Study Group on Pancreatic Fistula, and the postoperative complications were categorized according to the Clavien-Dindo classification. In addition, the costs of hospital treatment were verified using cost-effectiveness ratio (CER) and incremental (ICER) analysis.

Results: In the GWC, the incidence of POPF was significantly lower (16.7%) compared to the GWOC (39.7%); P =0.046, as well as the length of hospital stay in days (11.3 GWC, 16.2 GWOC; P =0.04) and the costs of hospital stay (GWOC US$ 3068,95; GWC US$ 2159,01; P =0.0413). In the cost-effectiveness analysis, we found an ICER of US$ -35,65, and in the total sample an ICER of -US$ -1513,13.

Conclusions: The use of synthetic cyanoacrylate glue to reinforce the PJA in patients undergoing PD under the conditions studied improved clinical postoperative results and hospitalization costs which justifies expanding studies, especially in circumstances of greater risk for postoperative pancreatic fistula.