Glubran® 2 in Hepato Bilio Pancreatic Surgery
SURGICAL SPECIALIZATION
Seal. Reinforce. Stabilize.
Reducing Bile and Pancreatic Leaks in Hepatobiliary Surgery
Glubran® 2 is a synthetic sealant with biliostatic, bacteriostatic, and hemostatic properties, demonstrating excellent performance in hepato-bilio-pancreatic surgery. It ensures tissue sealing, prevents bile and pancreatic leaks, and supports hemostasis in challenging surgical sites.
Indications of Use
Glubran® 2 is indicated for:
- Sealing and hemostasis in liver and pancreatic resections to prevent bilomas, fistulas, and postoperative bleeding.
- Sealing of anastomoses in bile and pancreatic duct reconstructions to prevent leaks.
- Reinforcement of vascular sutures, including during liver transplant procedures.
- Hemostasis of oozing hemorrhages after tissue detachments and dissections.
Clinical Evidence
An observational study evaluated the intraoperative application of nebulized Glubran® 2 sprayed on the resection surface in 205 patients undergoing liver resection for metastatic colorectal cancer (mCRC). The efficacy of this approach in preventing fistula formation was assessed, with clinical results demonstrating that the use of Glubran® 2 is a safe and feasible intraoperative procedure. It may significantly reduce the occurrence of bilomas and biliary fistulas.
| PARAMETRI | GLUBRAN® 2 | CONTROLLO | |
|---|---|---|---|
| Popolazione | N | 205 | 113 |
| Metastasi epatiche | 1075 | 452 | |
| N° metastasi/paziente | Mediana (range) | 4 (1-7) | 5 (2-6) |
| Giorni di ricovero | 8 (7-16) | 10 (5-14) | |
| Epatectomie maggiori | 151 (73) | 56 (50) | |
| Segmentectomie | n° (%) | 10 (5) | 40 (36) |
| Wedge e Settori ectomie | 34 (17) | 17 (14) | |
| Bilomi | % | 13* | 16 |
| Fistole | 1* | 2,6 | |
| Lesioni epatiche a 5 mesi (N) | N | 13 | 19 |
| Mortalità a 30 giorni | 0 | 0 |
| Parameter | |
| Patients (N) | |
| Hepatic metastases | |
| No. of metastases/patient Median (range) | |
| Major hepatectomies n (%) | |
| Segmental resections | |
| Wedges/Sectorectomies | |
| Days of hospital stay Median (range) | |
| Bilomas (%) | |
| Fistulas (%) | |
| Hepatic lesions at 5 months (N) | |
| Mortality at 30 days |
Key Takeways
- Significant reduction in bilomas and fistulas compared to control.
- Shorter hospital stays for treated patients.
- Safe and feasible, with no increase in 30-day mortality.
- Effective across all hepatectomy types, including major resections.
Dedicated Devices
Spray devices are indicated for nebulized application in thoracic surgery:
- Apply a thin, elastic film of Glubran® 2 for aerostatic and hemostatic purposes
- Gas supply autonomy: 8 continuous minutes
- Coverage: 1 mL per 15×15 cm (225 cm²)
- Facilitates suture reinforcement and uniform sealing of the parenchyma
These results confirm that Glubran® 2 is effective, safe, and cost-efficient in thoracic procedures.
| DEVICE | IMAGE | DISTANCE FROM TISSUE | NEBULIZING DIAMETER | INDICATIONS | EPATO-BILIO-PANCREATIC SURGERY |
|---|---|---|---|---|---|
| SPRAY DEVICE (G2-NBT) |
|
On large surfaces in laparoscopy | Hemostasis and sealing of resections, decortications and bullectomies | ||
| RIGID SPRAY DEVICE (G2-NBT RIG) |
|
5–7 cm | 4 cm | ||
| SHORT SPRAY DEVICE (G2-NBT SHORT) |
|
In open surgery | |||
| SMALL SPRAY DEVICE (G2-NBT SMALL) |
|
2–3 cm | 1 cm | On small surfaces in laparoscopy | Sealing,hemostasis and reinforcement of manual or mechanical suture lines |
| SHORT MINI SPRAY DEVICE (G2-NBT SM SHORT) |
|
In open |
Usage Protocol
- Prepare the device according to the procedure.
- Nebulize Glubran® 2 evenly over the target tissue. .
- Ensure full coverage of biliary ducts, pancreatic tissue, or vascular sutures requiring hemostasis.
- Monitor postoperatively following standard clinical protocols.
Quick, controlled application ensures immediate adhesion and prolonged sealing effect.
Bibliography
1. Amore A, Izzo F. Non soltanto un sigillante emostatico: evidenze cliniche delle proprietà biliostatiche del Glubran® 2. Proceedings XXXVIII Congresso SICO 2015; CIC Edizioni Internazionali, pag. 3-5.2.Albino V et al. Prevention of bilomas with cyanoacrylate-based surgical glue after major liver resection. SICO 2014 - Padova.
3.Lauterio A et al. Percutaneous Transhepatic Bile Duct Ablation with n-Butyl Cyanoacrylate after Split Liver Transplantation. J Transplant. 2009;4.
4.Esposito C et al. Experience with tissue adhesives in pediatric endoscopic surgery. Surg Endosc. 2004;18(2):290-2.
5.Granata V et al. Safety and Efficacy of Glubran® 2 as Biliostatic Agent in Liver Resection. Eur J Surg Oncol. 2020;46(2):e126.
6.Romano A et al. Endoscopic treatment for pancreatic fistula after distal pancreatectomy. Gastrointest Endosc. 2008;68(4):798-801.
7.Mutignani M et al. Endoscopic closure with N-butyl-2-cyanoacrylate. G Endoscopy. 2004;36(8):738-42.
8.Mezza T et al. Metabolic consequences of main pancreatic duct occlusion with acrylic glue. Am J Surg. 2015;210(4):783-9. 9-11. Additional references on pancreatic duct occlusion and fibrin sealants in liver surgery.