Abstract
Background
We previously reported the stump closure method for the remnant pancreas in distal
pancreatectomy, in which soft coagulation and polyglycolic acid felt attached with
fibrin glue were utilized. Transpancreatic mattress suture with polyglactin 910 woven
mesh was recently reported as a novel stump closure technique. We developed the modified
transpancreatic mattress suture with polyglactin 910 woven mesh method, which combined
our polyglycolic acid felt method with the transpancreatic mattress suture with polyglactin
910 woven mesh method.
Methods
The polyglycolic acid felt group included patients undergoing distal pancreatectomy
in whom the pancreatic stump was closed with the polyglycolic acid felt method from
2017 to 2018 (n = 54); whereas the modified transpancreatic mattress suture with polyglactin
910 woven mesh group included those whose stump was closed with the modified transpancreatic
mattress suture with polyglactin 910 woven mesh method from 2019 to 2020 (n = 51).
Perioperative parameters, including grade B/C postoperative pancreatic fistula (clinically
relevant postoperative pancreatic fistula), were assessed according to the stump closure
method.
Results
The incidence of clinically relevant postoperative pancreatic fistula was significantly
lower in the modified transpancreatic mattress suture with polyglactin 910 woven mesh
group than in the polyglycolic acid felt group (7.8% vs 22.2%, P = .036). In multivariate analysis, the use of neoadjuvant chemoradiotherapy and the
transpancreatic mattress suture with polyglactin 910 woven mesh method were independent
factors for preventing clinically relevant postoperative pancreatic fistula (P = .011 and 0.0038, respectively). Moreover, in the modified transpancreatic mattress
suture with polyglactin 910 woven mesh group, the incidence of clinically relevant
postoperative pancreatic fistula in patients with a thick pancreas (≥13 mm, 6.7%)
was comparably as low as that in patients with a thin pancreas (<13 mm, 9.5%).
Conclusion
The modified transpancreatic mattress suture with polyglactin 910 woven mesh method
is an effective stump closure technique to prevent clinically relevant postoperative
pancreatic fistula after distal pancreatectomy. Our results warrant further prospective
investigation to evaluate the efficacy of the modified transpancreatic mattress suture
with polyglactin 910 woven mesh method compared with other standard closure methods
(eg, stapler closure or hand-sewn closure).
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Article info
Publication history
Published online: June 27, 2022
Accepted:
May 16,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
