Effect of cyanoacrylate-based glue on postoperative leak and bleeding after pancreatectomy and sleeve gastrectomy: a systematic review and meta-analysis

AIMS: To investigate effect of cyanoacrylate-based glue on postoperative leak and bleeding after pancreatectomy and sleeve gastrectomy. METHODS: A PRISMA-compliant systematic review and meta-analysis using random effects modelling was performed including studies investigating effect of cyanoacrylate-based glue on postoperative leak and bleeding in patients undergoing pancreatectomy and sleeve gastrectomy. Proportion meta-analysis and comparison meta-analysis were modelled to evaluate the outcomes. RESULTS: Analysis of 1800 patients from nine studies showed no difference in the risk of postoperative leak between the cyanoacrylate-based glue and no glue groups in all pancreatic resections (OR: 1.26, p = 0.700), in pancreaticoduodenectomy with total duct occlusion (OR: 3.21, p = 0.360), in pancreaticoduodenectomy with pancreaticojejunostomy (OR: 0.42, p = 0.550), in distal pancreatectomy (OR: 1.50, p = 0.330), and in sleeve gastrectomy (OR: 0.14, p = 0.07). Moreover, there was no difference in the risk of postoperative bleeding between the cyanoacrylate-based glue and no glue groups in all pancreatic resections (OR: 1.44, p = 0.460), in pancreaticoduodenectomy with total duct occlusion (OR: 0.35, p = 0.520), in pancreaticoduodenectomy with pancreaticojejunostomy (OR: 2.75, p = 0.080), in distal pancreatectomy (OR: 0.72, p = 0.670), and in sleeve gastrectomy (OR: 0.37, p = 0.14). Cyanoacrylate-based glue did not reduce the risk of grade A (OR: 1.16, p = 0.82), grade B (OR: 1.29, p = 0.460), and grade C (OR: 0.36, 3.16, p = 0.360) postoperative pancreatic fistula. CONCLUSIONS: Level 2 evidence with moderate certainty suggests that cyanoacrylate-based glue does not reduce the risk of postoperative leak and bleeding after pancreatectomy and sleeve gastrectomy. More studies with larger sample sizes are required to exclude type 2 error.