Use of Hemopatch as a Sealant at the Pancreaticojejunostomy After Pancreatoduodenectomy
Use of Hemopatch as a Sealant at the Pancreaticojejunostomy After Pancreatoduodenectomy to Prevent Postoperative Pancreatic Fistula
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Pancreaticoduodenectomy (PD) is the most common surgical procedure to treat pancreatic tumors in the head of the pancreas and periampullary region, as well as benign processes such as chronic pancreatitis. Recent advances in surgical techniques and perioperative treatments have reduced perioperative mortality below 10% in high volume centers. However, PD is associated with considerable morbidity (40-58.5%) like postoperative pancreatic fistula, delayed gastric emptying, biliary fistula, postoperative hemorrhage, and pulmonary complications.
Several surgical techniques and perioperative care have been described to prevent or reduce the incidence of pancreatic fistula after PD, including reconstruction of the digestive tract with pancreaticogastrostomy, duc-to-mucosa reconstruction or pancreaticojejunostomy by intussusception, use of somatostatin and prophylactic analogues, the use of stents in the main pancreatic duct, and use of different sealants.
Although perioperative morbidity and mortality associated with PD have improved significantly over the years, even in high-volume centers, the incidence of postoperative fistula remains at 9.9-28.5%. Therefore, the ideal pancreatic reconstruction technique that prevents fistula is not yet available.
The use of sealants has been one of the approaches taken to try to reduce the rate of fistulas. Some uncontrolled or non-randomized studies have shown that the use of fibrin glue-based adhesives in combinations with felting patches can lead to a B / C grade fistula rate of 0-10%. Only 2 randomized clinical trials have been performed with fibrin glue, with opposite results in terms of significant reduction of pancreatic fistula.
Hemopatch is a patch consisting of a soft, thin and flexible pad of collagen derived from the bovine dermis, coated with NHS-PEG (pentaerythritol polyethylene glycol ether tetra-succinimidyl glutarate). It is intended to be a surgical sealant for procedures in which control of leakage by conventional surgical techniques is ineffective or impractical, making it a plausible option to use during PD in order to decrease postoperative pancreatic fistula.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 3
Contacts and Locations
Study Locations
-
-
-
Zaragoza, Spain, 50008
- Mario Serradilla Martín
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Patients scheduled for pancreatoduodenectomy by open approach, depending on the diagnosis/nature of the tumor.
- ASA score < 4.
- Male and female patients ≥ 18 and ≤ 80 years of age.
- With the consent form signed.
Exclusion Criteria:
- Patients scheduled for pancreatoduodenectomy by open approach, depending on the diagnosis/nature of the tumor.
- ASA score < 4.
- Male and female patients ≥ 18 and ≤ 80 years of age.
- With the consent form signed.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Prevention
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
No Intervention: Control
No reinforcement.
|
|
|
Experimental: Hemopatch
Reinforcement with Hemopatch.
|
Collagen patch derived from bovine dermis, coated with NHS-PEG, applied covering the pancreaticojejunostomy after pancreatoduodenectomy once the anastomosis is completed.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Postoperative type B and C pancreatic fistula
Time Frame: Up to 3 months
|
Postoperative type B and C pancreatic fistula rate defined according to the International Study Group of Pancreatic Fistula criteria, measured by amylases and/or lipases levels in the perianastomotic drainage
|
Up to 3 months
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Hospital stay
Time Frame: Up to 3 months
|
Days of duration
|
Up to 3 months
|
|
Stay in intensive care unit
Time Frame: Up to 3 months
|
Days of duration
|
Up to 3 months
|
|
Total postoperative fistula (including type A, B, and C)
Time Frame: Up to 3 months
|
Percentage of patients
|
Up to 3 months
|
|
Reoperations including interventional radiology
Time Frame: Up to 3 months
|
Percentage of patients
|
Up to 3 months
|
|
Delayed gastric emptying
Time Frame: Up to 3 months
|
Percentage of patients
|
Up to 3 months
|
|
Biliary fistula
Time Frame: Up to 3 months
|
Percentage of patients
|
Up to 3 months
|
|
Hemorrhage
Time Frame: Up to 3 months
|
Percentage of patients
|
Up to 3 months
|
|
Deep organ space complications
Time Frame: Up to 3 months
|
Deep organ space complications
|
Up to 3 months
|
|
Death, irrespective of cause
Time Frame: Up to 3 months
|
Death
|
Up to 3 months
|
|
Overall complications (according to Clavien-Dindo classification)
Time Frame: Up to 3 months
|
Percentage of patients
|
Up to 3 months
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Principal Investigator: Mario Serradilla, Hospital Miguel Servet
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- C1834-MADIT
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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