Discussion
PD, POPF
ADVERSE EVENTS, SECONDARY, COMPLICATIONS, POSTOPERATIVE COMPLICATIONS
The results of this study suggested that in patients who underwent PD with a PJ, the use of the PEG-coated collagen patch reduces the incidence of CR-POPF. Moreover, the capacity of the PEG-coated patch to prevent the onset of POPF was dependent on the FRS: the higher the FRS, the higher the protection. The incidences of adverse events were lower in the patch group compared with the control group, although no significant differences were observed in the specific postoperative complications analysed.Although different surgical approaches are currently used for PD, there does not seem to be an optimal technique that significantly decreases POPF ratesFrom a clinical point of view, POPF may be divided into ‘clinically relevant’ (grade B/C) and ‘not clinically relevant’ (biochemical leakage)The current study reported an overall POPF rate of 38 per cent (24/64 patients), which lies within the range of the published seriesAs far as the authors know, this is the first RCT evaluating the effectiveness of a PEG-coated haemostatic patch in PD, which makes it difficult to compare these results with the current evidence. Pisapia The decrease in CR-POPF rate observed in this study was not associated with a significant reduction in the incidence of other specific postoperative outcomes or a lower mortality rate.The use of sealants may be an option to reduce the incidence of POPF and, therefore, reducing life-threatening complications and healthcare costsNo evidence is currently available regarding the association of the use of the fibrin sealant patch (TachoSil™) in patients who undergo a PD with a lowering of the incidence of POPF or a reduction of its severityHemopatch™ is a PEG-covered collagen matrix, which has been proven to be an effective haemostat and sealant in different surgical proceduresThis study has some limitations that need to be taken into consideration. The main one is that it is a single-centre study, which included a small number of patients. The lack of differences in secondary outcomes may be due to the fact that the study was underpowered for detecting such differences. This study only used one type of reconstruction technique and appropriate caution is therefore recommended when extending the results to other reconstruction techniques. Finally, it should be mentioned that the use of interrupted suture in eight patients may have biased the results. Nevertheless, the incidence rate of POPF was similar for both suture techniques.Further research is needed to elucidate the role of different baseline factors in the effectiveness of the patch and the incidence of CR-POPF in larger, prospective multicentre controlled trials.