Ann Surg Treat Res.  2018 Oct;95(4):175-182. 10.4174/astr.2018.95.4.175.

Focal change of the pancreatic texture using a direct injection mixture of N-butyl cyanoacrylate and lipiodol in the pig model: a strategy for preventing pancreatic leakage during pancreatic surgery

• Kim EY
• Hong TH

• KMID: 2421195
• DOI: http://doi.org/10.4174/astr.2018.95.4.175

Abstract

PURPOSE
A soft texture of the pancreas is one of the most important predisposing factors for a pancreatic fistula. Thus, in a porcine model, we investigated a method to harden the pancreas locally by directly injecting an artificial material.
METHODS
During the laparotomy, 51 samples from 17 pigs, including 13 survival models, were randomly divided into 3 groups and either received a direct injection into the pancreas of MHL (1:4 mixture of histoacryl [n-butyl cyanoacrylate] and lipiodol) (group E) or saline (group C) or only received a pinprick into the pancreas without injecting a substance (sham). We measured the change in the pancreatic hardness after the injection using a durometer and examined the histological change of the pancreas using the fibrosis grade in the survival model.
RESULTS
The postinjection hardness of the pancreas was significantly increased in group E compared to group C and the sham group (P < 0.001). Pathologically, all cases in group E showed a severe fibrotic change, whereas the other groups demonstrated mild to no fibrosis (P < 0.001). The fibrosis in group E was localized to the area of the injection, while the surrounding areas were preserved.
CONCLUSION
The direct injection of MHL could induce focal hardening and fibrotic changes in the pancreas of the porcine model.

Keyword

Enbucrilate; Ethiodized oil; Pancreatic fistula; Pancreatic fibrosis

MeSH Terms

Causality
Cyanoacrylates*
Enbucrilate
Ethiodized Oil*
Fibrosis
Hardness
Laparotomy
Methods
Pancreas
Pancreatic Fistula
Swine
Cyanoacrylates
Enbucrilate
Ethiodized Oil

Figure

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  Fig. 1 View of the operation field. (A) The entire anterior surface of the pancreas was exposed, including the splenic and duodenal lobes. (B) After the injection of each substance into the pancreas (mixture of histoacryl and lipiodol or saline) or the pinprick, we marked the 3 different areas of the pancreas by clipping the connective tissue that was collinear to each treated area (arrows).

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  Fig. 2 Presence of the mixture of histoacryl and lipiodol was markedly revealed by X-ray film (arrow), which was taken on the 7th day following the injection for the survival model.

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  Fig. 3 Hardness of the pancreatic parenchyme was measured using a durometer in vivo (A) and ex vivo (B).

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  Fig. 4 Slide preparation was performed using the Masson trichrome staining method (original magnification x400). Fibrosis grade of the pancreas was estimated using the 4-stage scoring system as described by Wellner et al. [4] Briefly, the 4 grades include a normal pancreatic parenchyma without fibrotic changes (grade 0, A), mild fibrosis with thickened periductal fibrous tissue (grade 1, B), moderate fibrosis with marked sclerosis of the interlobular septa without evidence of architectural changes (grade 2, C), and severe fibrosis with detection of architectural destruction or acinar atrophy (grade 3, D).

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  Fig. 5 Focal change of the pancreatic parenchyme was confined to the mixture of histoacryl and lipiodol injection site (arrow) and not in the surrounding area, which was preserved to the normal structure of the pancreas (arrowhead), as shown in a cross-section (A) and during the histopathologic examination (B). Slide preparation was performed using the Masson trichrome staining method (original magnification x400).

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