This study investigates the safety and efficacy of injecting N-butyl-2-cyanoacrylate (Histoacryl®) into the pancreatic parenchyma during pancreaticoduodenectomy (PD) to enhance the security of the pancreaticojejunostomy (PJ) anastomosis and reduce postoperative pancreatic fistula (POPF) rates.
Patients undergoing pancreaticoduodenectomy for malignant lesions meeting the curative treatment intent in accordance with clinical guidelines.
Soft pancreatic texture.
Small main pancreatic duct diameter (<3 mm).
Informed consent obtained.
Known hypersensitivity to cyanoacrylate or Lipiodol®.
Extremely hard, fibrotic pancreas.
Significant pancreatitis involving the pancreatic remnant.
Active infection at the surgical site.
Single group
Pancreatic parenchymal injection of N-butyl-2-cyanoacrylate(Histoacryl®)
DrugThis procedure is integrated into the standard pancreaticoduodenectomy. Injection of Histoacryl® (n-butyl-2-cyanoacrylate) mixed with Lipiodol® (1:1 ratio) into the pancreatic parenchyma circumferentially (3, 6, 9, and 12 o'clock positions) around the main pancreatic duct (MPD) orifice, extending 5-8 mm deep and 5-10 mm laterally from the future anastomotic line, avoiding the main pancreatic duct and vessels. Total volume injected typically ranges from 0.2 ml to 0.6 ml. Follow with standard duct-to-mucosa pancreaticojejunostomy: * Tying down the posterior duct-to-mucosa sutures. * Placing and tying the anterior duct-to-mucosa sutures. * Tying down the posterior outer layer sutures. * Placing the anterior outer layer sutures. Meticulously avoid glue contact with sutures/mucosa Reconstruction: Complete the hepaticojejunostomy and duodenojejunostomy (or gastrojejunostomy).
Incidence of postoperative pancreatic fistula
A drainage fluid of any measurable volume with an amylase level more than three times the upper normal serum level on or after the 3rd postoperative day.
Incidence of postoperative acute pancreatitis
Altered serum amylase count on postoperative day 0 or 1
Incidence of Post-Pancreatectomy Hemorrhage
As defined by the International Study Group for Pancreatic Surgery (ISGPS), grade A, B and C rates
Incidence of intra-abdominal abscess
Collection containing gas bubbles, determining systemic signs of infection
Incidence of biliary fistula
Output of bile from drains on or by post operative day 3
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