Efficacy of Fibrin Glue and PGA Sheet for Pseudoaneurysm After Pancreatectomy: A Retrospective Study

Background/Aim: Pseudoaneurysm hemorrhage after pancreatectomy can be fatal. However, effective intraoperative preventive strategies remain unclear. This study evaluated the efficacy of fibrin glue combined with polyglycolic acid (PGA) sheet application to exposed vessels during pancreatectomy. Patients and Methods: This study included 280 patients who underwent pancreatectomy between 2016 and 2024 at Matsuyama Red Cross Hospital. Since May 2023, fibrin glue and PGA sheets were routinely applied to exposed vessels. Clinical outcomes, including the incidence of pseudoaneurysm and related complications, were compared between patients with and without this intervention. Results: Of the 280 patients, 169 (60.4%) underwent subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) and 111 (39.6%) underwent distal pancreatectomy (DP). Pseudoaneurysm-related hemorrhage occurred in nine patients (3.2%): eight (4.7%) after SSPPD and one (0.9%) after DP. Identified risk factors included soft pancreatic texture, clinically relevant pancreatic fistula, delayed gastric emptying, intra-abdominal infection, and sepsis. Patients with pseudoaneurysm experienced significantly longer hospital stays (p<0.0001). While the incidence of pseudoaneurysm was similar between groups, those treated with fibrin glue and PGA sheets tended to require less transfusion and ICU care. Eight of the nine cases were successfully managed with endovascular stent grafts, with no stent-related complications observed. Conclusion: Although the use of fibrin glue with PGA sheets did not reduce the incidence of pseudoaneurysm hemorrhage, it may attenuate the severity and urgency of bleeding, facilitating safer and more effective treatment.