Stents, glue, etc. Is anything proven to help prevent pancreatic leaks/fistulae?

Although mortality from pancreaticoduodenectomy has improved dramatically over the past three decades, morbidity from this operation remains high. A significant contributor to postoperative morbidity is pancreatic leak and fistula. Level one evidence does not support the use of octreotide to prevent pancreatic fistula (in five of six trials). Nor does it support the use of internal pancreatic duct stents.Arandomized controlled trial from Hong Kong did demonstrate improvement in pancreatic fistula rate, decreased use of intensive care, and decreased use of parenteral nutrition when an external pancreatic duct stent was used. However, the impact is difficult to interpret in the context of common practices in many Western centers. Level one evidence does not support the use of topical or intraductal fibrin glue to decrease pancreatic fistula or intra-abdominal complications.