Role of Platelet Rich Fibrin (PRF) in Pancreatico-Jejunostomy in patients undergoing Pancreatoduodenectomy – A Randomized Controlled Trial

Platelet rich fibrin (PRF) is a new generation of platelet concentrates. It was first developed by Choukrroun et al in France for use in maxillofacial surgery. It is an autologous bio-scaffold which can be prepared easily and does not require biochemical manipulation. It contains fibrin, leukocytes, cytokines and growth factors which are known to accelerate tissue healing. The coagulum acts as a reservoir for growth factors which promote neovascularization, increased wound closing with fast cicatricial tissue re-modelling and reduction of infectious events.

Its use in clinical practice is manifold with majority published clinical use in oro-maxillofacial, orthopaedicians, cardiothoracic, plastic surgery and dermatology.

Experimental models have demonstrated significant benefits in rat, porcine and rabbit models for intestinal anastomosis, colonic anastomosis, airway anastomosis and even dura mater closure.

POPF remains the single main determinant of serious postoperative morbidity and mortality related to pancreatic resection and plays a major role in terms of operation-related mortality, morbidity, hospital stay, and economic impact. Despite all the advances and technical modifications developed during this past decade to prevent POPF, the incidence of this dreaded complication still ranges between 3–45 % of pancreatic operations at high volume centers.

The use of PRF on Pancreatic Anastomosis has not been evaluated in human studies yet. PRF is routinely being used in various other surgeries including at our centre in wound related issues, complex fistulas and joint related issues with favourable results. Our unit currently has an ongoing study on the effects of PRF on Bile Duct Anastomosis in LDLT. No complications have been reported so far.

With this background, we want to conduct this study for evaluation of the role of PRF in Pancreatic anastomosis.