Cochrane · systematic review · CD009621
Fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery
Lai, M, Zhou, S, He, S, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
22
current version
GRADE rated
18
No studies
4
Included studies
NR
No studies 4 · 18.2%Ungraded 0 · 0%Very low 10 · 45.5%Low 8 · 36.4%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyApplication of fibrin sealants to pancreatic stump closure reinforcement for the prevention of postoperative pancreatic fistula following distal pancreatectomy
Population: people undergoing distal pancreatectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (grade B or C) | RR 0.94 [0.73, 1.21] | 5 studies · 1002 participants | Low Downgraded: risk of bias, imprecision |
Postoperative mortality | Peto OR 0.39 [0.12, 1.29] | 7 studies · 1051 participants | Very low Downgraded: risk of bias, imprecision |
Overall postoperative morbidity | RR 1.2 [0.98, 1.48] | 4 studies · 893 participants | Low Downgraded: risk of bias, imprecision |
Reoperation rate | RR 0.4 [0.18, 0.9] | 3 studies · 623 participants | Low Downgraded: risk of bias, imprecision |
Serious adverse events | no estimate extracted | 5 studies · 732 participants | Low Downgraded: risk of bias, imprecision |
Cost‐effectiveness | no estimate extracted | NR | No studies |
Total length of hospital stay (days) | MD 0.99 | 2 studies · 371 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Application of fibrin sealants to pancreatic anastomosis reinforcement for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy
Population: people undergoing pancreaticoduodenectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (grade B or C) | 1.34 [0.72, 2.48] | 3 studies · 323 participants | Very low Downgraded: risk of bias, imprecision |
Postoperative mortality | Peto OR 0.24 [0.05, 1.06] | 5 studies · 517 participants | Very low Downgraded: risk of bias, imprecision |
Overall postoperative morbidity | 1.02 [0.87, 1.19] | 4 studies · 447 participants | Low Downgraded: risk of bias, imprecision |
Reoperation rate | RR 0.74 [0.33, 1.66] | 3 studies · 323 participants | Very low Downgraded: risk of bias, imprecision |
Serious adverse events | no estimate extracted | 2 studies · 194 participants | Very low Downgraded: risk of bias, imprecision |
Total hospital cost (US dollars) | no estimate extracted | 1 study · 124 participants | Very low Downgraded: risk of bias, imprecision |
Total length of hospital stay (days) | no estimate extracted | 4 studies · 447 participants | Low Downgraded: risk of bias, imprecision |
Application of fibrin sealants to pancreatic duct occlusion for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy
Population: people undergoing pancreaticoduodenectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (grade B or C) | no estimate extracted | NR | No studies |
Postoperative mortality | Peto OR 1.41 [0.63, 3.13] | 2 studies · 351 participants | Very low Downgraded: risk of bias, imprecision |
Overall postoperative morbidity | RR 1.16 [0.67, 2.02] | 2 studies · 351 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Reoperation rate | RR 0.85 [0.52, 1.41] | 2 studies · 351 participants | Very low Downgraded: risk of bias, imprecision |
Serious adverse events (diabetes mellitus) | no estimate extracted | 1 study · 169 participants | Low Downgraded: risk of bias, imprecision |
Quality of life | no estimate extracted | NR | No studies |
Cost‐effectiveness | no estimate extracted | NR | No studies |
Total length of hospital stay (days) | no estimate extracted | 2 studies · 351 participants | Low Downgraded: risk of bias, imprecision |
Application of fibrin sealants to pancreatic stump closure reinforcement for the prevention of postoperative pancreatic fistula following distal pancreatectomy
Population: people undergoing distal pancreatectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (ISGPF definition) | RR 0.96 [0.68, 1.35] | 4 studies · 755 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Postoperative mortality | Peto OR 0.52 [0.05, 5.03] | 6 studies · 804 participants | Low Downgraded: imprecision, publication bias |
Overall postoperative morbidity | RR 1.23 [0.97, 1.58] | 3 studies · 646 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Reoperation rate | RR 0.51 [0.15, 1.71] | 2 studies · 376 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Cost‐effectiveness | no estimate extracted | NR | No studies |
Length of hospital stay (days) | MD 0.99 | 2 studies · 371 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Application of fibrin sealants to pancreatic anastomosis reinforcement for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy
Population: people undergoing pancreaticoduodenectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (ISGPF definition) | RR 1.14 [0.28, 4.69] | 2 studies · 199 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Postoperative mortality | Peto OR 0.26 [0.05, 1.32] | 4 studies · 393 participants | Low Downgraded: imprecision, publication bias |
Overall postoperative morbidity | RR 1.04 [0.87, 1.24] | 3 studies · 323 participants | Moderate Downgraded: risk of bias, publication bias |
Reoperation rate | RR 0.74 [0.33, 1.66] | 3 studies · 323 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Cost‐effectiveness | no estimate extracted | NR | No studies |
Length of hospital stay (days) | MD 0.01 | 3 studies · 323 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Application of fibrin sealants to pancreatic duct occlusion for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy
Population: people undergoing pancreaticoduodenectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (ISGPF definition) | no estimate extracted | NR | No studies |
Postoperative mortality | Peto OR 1.41 [0.63, 3.13] | 2 studies · 351 participants | Low Downgraded: imprecision, publication bias |
Overall postoperative morbidity | RR 1.16 [0.67, 2.02] | 2 studies · 351 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Reoperation rate | RR 0.85 [0.52, 1.41] | 2 studies · 351 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events (Diabetes mellitus) | no estimate extracted | 1 study · 169 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Quality of life | no estimate extracted | NR | No studies |
Cost‐effectiveness | no estimate extracted | NR | No studies |
Length of hospital stay (days) | no estimate extracted | 2 studies · 351 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Application of fibrin sealants to pancreatic stump closure reinforcement for the prevention of postoperative pancreatic fistula following distal pancreatectomy
Population: people undergoing distal pancreatectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (ISGPF definition) | RR 0.96 [0.68, 1.35] | 4 studies · 755 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Postoperative mortality | Peto OR 0.52 [0.05, 5.03] | 6 studies · 804 participants | Low Downgraded: imprecision, publication bias |
Overall postoperative morbidity | RR 1.23 [0.97, 1.58] | 3 studies · 646 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Reoperation rate | RR 0.51 [0.15, 1.71] | 2 studies · 376 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Cost effectiveness | no estimate extracted | NR | No studies |
Length of hospital stay (days) | MD 0.32 | 4 studies · 755 participants | Moderate Downgraded: risk of bias, publication bias |
Application of fibrin sealants to pancreatic anastomosis reinforcement for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy
Population: people undergoing pancreaticoduodenectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (ISGPF definition) | RR 0.25 [0.01, 5.06] | 1 study · 57 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Postoperative mortality | Peto OR 0.15 [0, 7.76] | 3 studies · 251 participants | Low Downgraded: imprecision, publication bias |
Overall postoperative morbidity | RR 0.97 [0.65, 1.45] | 2 studies · 181 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Reoperation rate | RR 0.83 [0.33, 2.11] | 2 studies · 181 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events | no estimate extracted | NR | No studies |
Quality of life | no estimate extracted | NR | No studies |
Cost effectiveness | no estimate extracted | NR | No studies |
Length of hospital stay (days) | no estimate extracted | 2 studies · 181 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Application of fibrin sealants to pancreatic duct occlusion for the prevention of postoperative pancreatic fistula following pancreaticoduodenectomy
Population: people undergoing pancreaticoduodenectomy
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula (ISGPF definition) | no estimate extracted | NR | No studies |
Postoperative mortality | Peto OR 1.41 [0.63, 3.13] | 2 studies · 351 participants | Low Downgraded: imprecision, publication bias |
Overall postoperative morbidity | RR 1.16 [0.67, 2.02] | 2 studies · 351 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Reoperation rate | RR 0.85 [0.52, 1.41] | 2 studies · 351 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Serious adverse events (Diabetes mellitus) | no estimate extracted | 1 study · 169 participants | Low Downgraded: risk of bias, imprecision |
Quality of life | no estimate extracted | NR | No studies |
Cost effectiveness | no estimate extracted | NR | No studies |
Length of hospital stay (days) | MD 0.58 | 2 studies · 351 participants | Low Downgraded: risk of bias, imprecision |
Fibrin sealants versus no fibrin sealants for the prevention of postoperative pancreatic fistula following pancreatic surgery
Population: Patients undergoing pancreatic resections
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Postoperative pancreatic fistula Fibrin sealants vs no fibrin sealants | RR 0.93 [0.71, 1.21] | 9 studies · 1095 participants | Low Downgraded: risk of bias, imprecision, publication bias |
Postoperative mortality Fibrin sealants vs no fibrin sealants | Peto OR 1.29 [0.59, 2.82] | 8 studies · 1039 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Overall postoperative morbidity Fibrin sealants vs no fibrin sealants | RR 1.04 [0.82, 1.32] | 5 studies · 797 participants | Very low Downgraded: risk of bias, imprecision, publication bias |
Reoperation rate Fibrin sealants vs no fibrin sealants | RR 0.8 [0.53, 1.21] | 5 studies · 807 participants | Very low Downgraded: risk of bias, imprecision, publication bias |