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Original Investigation
October 26, 2016

Effect of Polyglycolic Acid Mesh for Prevention of Pancreatic Fistula Following Distal PancreatectomyA Randomized Clinical Trial

Author Affiliations
  • 1Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
  • 2Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
  • 3Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 4Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
  • 5Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
  • 6Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
JAMA Surg. Published online October 26, 2016. doi:10.1001/jamasurg.2016.3644
Key Points

Question  Is polyglycolic acid mesh effective in preventing postoperative pancreatic fistula after distal pancreatectomy?

Findings  In this randomized clinical trial of 97 patients (44 in the polyglycolic acidgroup and 53 in the control group), the rate of clinically relevant postoperative pancreatic fistula (grade B or C) was significantly lower in the polyglycolic acid group than in the control group (11.4% vs 28.3%).

Meaning  Wrapping of the cut surface of the pancreas with polyglycolic acid mesh can significantly reduce the rate of clinically relevant postoperative pancreatic fistula.

Abstract

Importance  The rate of postoperative pancreatic fistula (POPF) after distal pancreatectomy ranges from 13% to 64%. To prevent POPF, polyglycolic acid (PGA) mesh was introduced, but its effect has been evaluated only in small numbers of patients and retrospective studies.

Objective  To evaluate the efficacy of PGA mesh in preventing POPF after distal pancreatectomy.

Design, Setting, and Participants  Prospective randomized clinical, single-blind (participant), parallel-group trial at 5 centers between November 2011 and April 2014. The pancreatic parenchyma was divided using a stapling device; no patient was given prophylactic octreotide. Perioperative and clinical outcomes were compared including POPF, which was graded according to the criteria of the International Study Group For Pancreatic Fistulas. A total of 97 patients aged 20 to 85 years with curable benign, premalignant, or malignant disease of the pancreatic body or tail were enrolled (44 in the PGA group and 53 in the control group).

Interventions  Patients in the PGA group underwent transection of the pancreas and application of fibrin glue followed by wrapping the PGA mesh around the remnant pancreatic stump.

Main Outcomes and Measures  The primary end point of this study was the development of a clinically relevant POPF (grade B or C by the International Study Group grading system). The secondary end point was the evaluation of risk factors for POPF.

Results  The study therefore evaluated a total of 97 patients, 44 in the PGA group and 53 in the control group. Thirty-nine patients were women and 58 patients were men. There were no differences in mean (SD) age (59.9 [12.0] years vs 54.5 [14.1] years, P = .05), male to female ratio (1.0:1.3 vs 1.0:1.7, P = .59), malignancy (40.9% vs 32.1%, P = .37), mean (SD) pancreatic duct diameter (1.92 [0.75] mm vs 1.94 [0.95] mm, P = .47), soft pancreatic texture (90.9% vs 83.0%, P = .17), and mean (SD) thickness of the transection margin (16.9 [5.4] mm vs 16.4 [4.9] mm, P = .63) between the PGA and control groups. The rate of clinically relevant POPF (grade B or C) was significantly lower in the PGA group than in the control group (11.4% vs 28.3%, P = .04).

Conclusions and Relevance  Wrapping of the cut surface of the pancreas with PGA mesh is associated with a significantly reduced rate of clinically relevant POPF.

Trial Registration  clinicaltrials.gov Identifier: NCT01550406.

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