Case Report
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 21, 2011; 17(35): 4044-4047
Published online Sep 21, 2011. doi: 10.3748/wjg.v17.i35.4044
Collagen-based biological glue after Appleby operation for advanced gastric cancer
Gianluca Baiocchi, Nazario Portolani, Federico Gheza, Stefano M Giulini
Gianluca Baiocchi, Nazario Portolani, Federico Gheza, Stefano M Giulini, Department of Medical and Surgical Sciences, Surgical Clinic, Brescia University, 25127 Brescia, Italy
Author contributions: Baiocchi G and Portolani N clinically managed the patient; Giulini SM and Portolani N performed surgery; Baiocchi G and Gheza F wrote the manuscript. All authors approved the final version of the manuscript.
Correspondence to: Dr. Gian Luca Baiocchi, Department of Medical and Surgical Sciences, Surgical Clinic, Brescia University, 25127 Brescia, Italy. baiocchi@med.unibs.it
Telephone: +39-030-3995600 Fax: +39-030-3397476
Received: January 8, 2010
Revised: February 10, 2011
Accepted: February 17, 2011
Published online: September 21, 2011
Abstract

Pancreatic fistula is a common complication of distal pancreatectomy; although various surgical procedures have been proposed, no clear advantage is evident for a single technique. We herein report the case of a 38-year-old patient affected by an advanced gastric carcinoma infiltrating the pancreas body, with extensive nodal metastases involving the celiac trunk, who underwent total gastrectomy with lymphadenectomy, distal pancreatectomy and resection en bloc of the celiac trunk (Appleby operation). At the end of the demolitive phase, the pancreatic stump and the aorta at the level of the celiac ligature were covered with a layer of Tachosil®, a horse collagen sponge made with human coagulation factors (fibrinogen and thrombin). Presenting this case, we wish to highlight the possible sealing effect of this product and hypothesize a role in preventing pancreatic fistula and postoperative lymphorrhagia from extensive nodal dissection.

Keywords: Gastric cancer; Pancreatic fistula; Vascular infiltration; Biologic sealant