Pancreaticojejunostomy by reinforcing the pancreas without covering the anastomotic line reduces pancreatic fistula

Abstract

Applying PGA felt pasting to PJ anastomosis could be one effective measure for reducing POPF after PD.

Prevention of pancreatic fistula using polyethylene glycolic acid mesh reinforcement around pancreatojejunostomy: the propensity score-matched analysis

“…The PGA mesh was used in many surgical procedures, for the prevention of CSF leakage during dura repair of spine and for hemostasis of splenic rupture . This finding was in good agreement with other studies showing the efficacy of PGA mesh after pancreatic resection .…”

“…In contrast, the efficacy of PGA mesh in PD remains unclear. Although two studies reported that PGA mesh significantly reduced POPF rates after PD (5.6% vs. 38.9%, P = 0.016 [13]; and 39.1% vs. 70.0%, P = 0.042 [14]), a third study found that PGA mesh had no effect on POPF (34% vs. 44%, P = 0.355) [15]. The present study was therefore designed to investigate the ability of PGA mesh to reinforce the pancreaticojejunostomy anastomosis after PD, finding that PGA mesh significantly reduced rates of POPF and especially of clinically relevant POPF.…”

“…Many methods to reduce the incidence of POPF have been tested, including pancreatic duct stenting, reinforcement of the pancreatic stump and creation of a new pancreatico‐enteric anastomosis . Recent small‐scale studies have shown that wrapping polyethylene glycolic acid (PGA) mesh around the anastomotic site reinforced the pancreaticojejunostomy following PD with favorable clinical outcomes . This study was performed to investigate the efficacy of PGA mesh in reducing POPF and to evaluate other risk factors for POPF in patients who underwent pancreatic surgery.…”

Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy

“…Ten studies [ 7 – 12 , 14 – 17 ] reported overall POPF, 2 studies [ 8 , 15 ] reported that PGA mesh decreased the incidence of POPF, and 8 studies reported no significant association. [ 7 , 9 – 12 , 14 , 16 , 17 ] Moderate heterogeneity ( I 2 = 35%, P = .13) was detected, so we chose a random-effect model to pool the data (RR = 0.76, 95% CI = 0.64–0.89, P = .0009). Overall, the pooled data demonstrated that the POPF in the PGA group was significantly lower than the control group.…”

A simple pancreaticojejunostomy technique for hard pancreases using only two transpancreatic sutures with buttresses: a comparison with the previous pancreaticogastrostomy and dunking methods

“…Each POPF is classified as grades A, B, or C based on the ISGPF criteria as follows: grade A, POPF is clinically stable and requires no treatment or admission; grade B, POPF shows fluid collection on CT scan and may require treatment and/or readmission; and grade C, POPF requires treatment or reoperation, and sepsis or infection may be present [ 7 ]. In this study, only grade B or C POPFs were considered clinically significant POPFs because there were no differences between cases with grade A POPFs and without fistulas in terms of clinical findings and progression [ 8 9 ]. Drains were kept in place for at least 5 days after surgery, and the properties and volume of the drained fluid were recorded.…”