Effect of Polyglycolic Acid Mesh for Prevention of Pancreatic Fistula After Pancreatectomy: A Systematic Review and Meta-analysis

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2020 Aug 28

PMID 32846759

Citations 3

Authors

Wei Zhang

Zhicheng Wei

Xu Che

Affiliations

Soon will be listed here.

Abstract

Postoperative pancreatic fistula (POPF) is the most common and intractable complication after partial pancreatectomy, with an incidence of 13% to 64%. Polyglycolic acid (PGA) mesh is a new technique that is designed to prevent POPF, and its effect has been evaluated in several randomized controlled trials and some retrospective cohort studies. In this study, we systematically and comprehensively analyzed the efficacy of PGA mesh based on reported studies.We searched Medline, Embase, and Cochrane Library databases in English between January 2010 and October 2019. Analysis was performed by using Review Manger 5.3 software.Three RCTs and 8 nonrandomized studies were eligible with a total of 1598 patients including 884 PGA group patients and 714 control group patients. For pancreatoduodenectomy (PD), distal pancreatectomy (DP), and the 2 partial pancreatectomy (PD or DP), we found significant statistical differences in overall POPF (relative risk [RR] = 0.75, 95% confidence interval [CI] = 0.61-0.91, P = .004; RR = 0.74, 95% CI = 0.57-0.96, P = .02; RR = 0.76, 95% CI = 0.64-0.89, P = .0009, respectively) and clinical pancreatic fistula (PF) (RR = 0.5, 95% CI = 0.37-0.68, P < .00001; RR = 0.31, 95% CI = 0.21-0.46, P < .00001; RR = 0.41, 95% CI = 0.32-0.52, P < .00001, respectively) in favor of PGA. For partial pancreatectomy, significant statistical differences were found in overall complications (RR = 0.77, 95% CI: 0.67-0.88, P = .0002) and estimated blood loss (weighted mean difference [WMD] = -53.58; 95% CI: -101.20 to -5.97, P = .03) in favor of PGA. We did not find significant differences regarding operative time (WMD = -8.86; 95% CI: -27.59 to 9.87, P = .35) and hospital stay (WMD = -2.73; 95% CI: -7.53 to 2.06, P = .26).This meta-analysis shows the benefits of the PGA mesh technique regarding POPF, clinical PF, and postoperative complications. This still needs to be verified by more randomized control trials.

Citing Articles

Development and validation of a novel pancreaticojejunostomy strategy based on the anatomical location of the main pancreatic duct that can reduce the risk of postoperative pancreatic fistula after pancreatoduodenectomy.

Xue K, Wang L, Chen L, Liu X, Li A, Wang Z Gland Surg. 2024; 13(10):1693-1707.

PMID: 39544981 PMC: 11558298. DOI: 10.21037/gs-24-235.

Effect of artificial or autologous coverage of the pancreatic remnant or anastomosis on postoperative pancreatic fistulas after partial pancreatectomy: meta-analysis of randomized clinical trials.

Walber J, Antony P, Strothmann H, Kalkum E, Renzulli P, Hauswirth F BJS Open. 2024; 8(3).

PMID: 38814751 PMC: 11138960. DOI: 10.1093/bjsopen/zrae059.

Efficacy of the polyglycolic acid sheet for preventing anastomotic leakage in double-stapling technique anastomosis for left-sided colon or rectal cancer surgery: a propensity score-matched study.

Shibutani M, Fukuoka T, Iseki Y, Kasashima H, Maeda K BMC Surg. 2023; 23(1):135.

PMID: 37198625 PMC: 10193689. DOI: 10.1186/s12893-023-02044-0.

References

Kuramoto M, Ikeshima S, Shimada S, Yamamoto K, Masuda T, Nakamura K . Pancreaticojejunostomy by reinforcing the pancreas without covering the anastomotic line reduces pancreatic fistula. Int J Surg. 2013; 11(9):909-13. DOI: 10.1016/j.ijsu.2013.07.007. View

Ceonzo K, Gaynor A, Shaffer L, Kojima K, Vacanti C, Stahl G . Polyglycolic acid-induced inflammation: role of hydrolysis and resulting complement activation. Tissue Eng. 2006; 12(2):301-8. PMC: 1769522. DOI: 10.1089/ten.2006.12.301. View

Hayashibe A, Ogino N . Clinical study for pancreatic fistula after distal pancreatectomy with mesh reinforcement. Asian J Surg. 2016; 41(3):236-240. DOI: 10.1016/j.asjsur.2016.11.001. View

Thaker R, Matthews B, Linehan D, Strasberg S, Eagon J, Hawkins W . Absorbable mesh reinforcement of a stapled pancreatic transection line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg. 2007; 11(1):59-65. DOI: 10.1007/s11605-006-0042-6. View

Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M . The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017; 161(3):584-591. DOI: 10.1016/j.surg.2016.11.014. View

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J . Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138(1):8-13. DOI: 10.1016/j.surg.2005.05.001. View

Shimada Y, Hongo M, Miyakoshi N, Sugawara T, Kasukawa Y, Ando S . Dural substitute with polyglycolic acid mesh and fibrin glue for dural repair: technical note and preliminary results. J Orthop Sci. 2006; 11(5):454-8. DOI: 10.1007/s00776-006-1044-7. View

Schindl M, Fugger R, Gotzinger P, Langle F, Zitt M, Stattner S . Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy. Br J Surg. 2018; 105(7):811-819. PMC: 5989938. DOI: 10.1002/bjs.10840. View

Allen P, Gonen M, Brennan M, Bucknor A, Robinson L, Pappas M . Pasireotide for postoperative pancreatic fistula. N Engl J Med. 2014; 370(21):2014-22. DOI: 10.1056/NEJMoa1313688. View

10.

Gouma D, van Geenen R, van Gulik T, de Haan R, de Wit L, Busch O . Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000; 232(6):786-95. PMC: 1421271. DOI: 10.1097/00000658-200012000-00007. View

11.

Yoshino J, Ban D, Ogura T, Ogawa K, Ono H, Mitsunori Y . The Clinical Implications of Peripancreatic Fluid Collection After Distal Pancreatectomy. World J Surg. 2019; 43(8):2069-2076. DOI: 10.1007/s00268-019-05009-8. View

12.

Pulvirenti A, Landoni L, Borin A, De Pastena M, Fontana M, Pea A . Reinforced stapler versus ultrasonic dissector for pancreatic transection and stump closure for distal pancreatectomy: A propensity matched analysis. Surgery. 2019; 166(3):271-276. DOI: 10.1016/j.surg.2019.02.016. View

13.

Hamilton N, Porembka M, Johnston F, Gao F, Strasberg S, Linehan D . Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial. Ann Surg. 2012; 255(6):1037-42. PMC: 3363360. DOI: 10.1097/SLA.0b013e31825659ef. View

14.

Kondo N, Uemura K, Nakagawa N, Okada K, Kuroda S, Sudo T . A Multicenter, Randomized, Controlled Trial Comparing Reinforced Staplers with Bare Staplers During Distal Pancreatectomy (HiSCO-07 Trial). Ann Surg Oncol. 2019; 26(5):1519-1527. DOI: 10.1245/s10434-019-07222-0. View

15.

Ferrone C, Warshaw A, Rattner D, Berger D, Zheng H, Rawal B . Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg. 2008; 12(10):1691-7. PMC: 3806097. DOI: 10.1007/s11605-008-0636-2. View

16.

Balzano G, Zerbi A, Cristallo M, Di Carlo V . The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg. 2005; 9(6):837-42. DOI: 10.1016/j.gassur.2005.01.287. View

17.

Satoi S, Toyokawa H, Yanagimoto H, Yamamoto T, Hirooka S, Yui R . Reinforcement of pancreticojejunostomy using polyglycolic acid mesh and fibrin glue sealant. Pancreas. 2010; 40(1):16-20. DOI: 10.1097/MPA.0b013e3181f82f55. View

18.

Masuda S, Fujibayashi S, Otsuki B, Kimura H, Neo M, Matsuda S . The dural repair using the combination of polyglycolic acid mesh and fibrin glue and postoperative management in spine surgery. J Orthop Sci. 2016; 21(5):586-90. DOI: 10.1016/j.jos.2016.07.016. View

19.

Pedrazzoli S, Liessi G, Pasquali C, Ragazzi R, Berselli M, Sperti C . Postoperative pancreatic fistulas: preventing severe complications and reducing reoperation and mortality rate. Ann Surg. 2008; 249(1):97-104. DOI: 10.1097/SLA.0b013e31819274fe. View

20.

Johnston F, Cavataio A, Strasberg S, Hamilton N, Simon Jr P, Trinkaus K . The effect of mesh reinforcement of a stapled transection line on the rate of pancreatic occlusion failure after distal pancreatectomy: review of a single institution's experience. HPB (Oxford). 2009; 11(1):25-31. PMC: 2697864. DOI: 10.1111/j.1477-2574.2008.00001.x. View