Effect of Polyglycolic Acid Mesh for Prevention of Pancreatic Fistula Following Distal Pancreatectomy

Jang, Jin Young; Shin, Yong Chan; Park, Joon Seong; Han, Ho Seong; Hwang, Ho Kyoung; Yoon, Dong Sup; Kim, Jae Keun; Yoon, Yoo Seok; Hwang, Dae Wook; Kang, Chang Moo; Lee, Woo Jung; Heo, Jin Seok; Kang, Mee Joo; Chang, Young Soo; Chang, Jihoon; Jung, Woohyun; Kim, Sun Whe

doi:10.1001/jamasurg.2016.3644

Cited by 86 publications

(86 citation statements)

References 26 publications

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“…The original search strategy identified 1205 potentially relevant articles, yielding 16 RCTs that satisfied the inclusion and exclusion criteria, and were therefore included in the quantitative analysis ( Fig . ).…”

Section: Resultsmentioning

confidence: 99%

“…Studies performed consistently well in the complete reporting of data, limiting the risk of attrition bias, and random sequence generators used were generally efficacious. However, notable deficiencies were identified in blinding of the outcome assessment (12 studies).…”

Section: Resultsmentioning

confidence: 99%

“…Numerous RCTs have compared these different stump closure techniques, with varying results. Furthermore, published meta‐analyses comparing various stump closure techniques have been limited to pairwise outcome data, again with conflicting results.…”

Section: Introductionmentioning

confidence: 99%

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Network meta-analysis comparing techniques and outcomes of stump closure after distal pancreatectomy

Ratnayake

Wells

Hammond

et al. 2019

British Journal of Surgery

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Background: The incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy remains high, and different pancreatic stump closure techniques have been used to reduce the incidence. A network meta-analysis was undertaken to compare the most frequently performed pancreatic stump closure techniques after distal pancreatectomy and determine the technique associated with the lowest POPF rate. Methods: A systematic search of the Scopus, PubMed, MEDLINE and Embase databases was conducted to identify eligible RCTs. The primary outcome was the occurrence of clinically relevant POPF. Secondary outcomes were duration of operation, blood loss, intrabdominal collections, postoperative complications and 30-day mortality. Results: Sixteen RCTs including 1984 patients and eight different pancreatic stump closure techniques were included in the network meta-analysis. Patch coverage of the pancreatic stump (round ligament or seromuscular patch) after stapler or suture closure ranked best, with the lowest rates of clinically relevant POPF, lowest volume of intraoperative blood loss, fewer intra-abdominal abscesses, and lower rates of overall complications and 30-day mortality. Round ligament patch closure outperformed seromuscular patch closure in preventing clinically relevant POPF with a significantly larger cohort for comparative analysis. Pancreaticoenteric anastomotic closure consistently ranked poorly for most reported postoperative outcomes. Conclusion: Patch coverage after stapler or suture closure has the lowest POPF rate and best outcomes among stump closure techniques after distal pancreatectomy.or pancreaticogastric 7 anastomosis, ultrasonic 8 or radiofrequency 9 ablation, application of fibrin glue to cover the pancreatic stump 10 , mesh application to the stump or to reinforce staple lines 11 , and use of autologous patches with the round ligament 12 (Fig. 1).Numerous RCTs 7,13 -21 have compared these different stump closure techniques, with varying results. Furthermore, published meta-analyses 2,22 -26 comparing various stump closure techniques have been limited to pairwise outcome data, again with conflicting results. Network meta-analysis allows multiple simultaneous direct and indirect comparisons of different techniques while maintaining the randomization throughout the analysis. The aim of this network meta-analysis was to compare the most frequently

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Network meta-analysis comparing techniques and outcomes of stump closure after distal pancreatectomy

Ratnayake

Wells

Hammond

et al. 2019

British Journal of Surgery

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“…Polyethylene glycolic acid mesh is a bioabsorbable recombinant membrane made of a synthetic polymer with a cellulose‐like structure . A randomized control trial testing the ability of PGA mesh to reduce POPF after distal pancreatectomy reported that 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 = 0.040) . Following the completion of pancreaticojejunostomy, surgeons can easily wrap the anastomotic site with PGA mesh because it is easy to manipulate.…”

Section: Discussionmentioning

confidence: 99%

“…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 [29,30]. This finding was in good agreement with other studies showing the efficacy of PGA mesh after pancreatic resection [13,14,28].…”

Section: Discussionmentioning

confidence: 99%

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

Kang

Han

Kim

et al. 2017

J Hepatobiliary Pancreat Sci

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Polyglycolic Acid Mesh in Distal Pancreatectomy

Juo

Hines

2017

JAMA Surg

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Postoperative pancreatic fistula (POPF) is the most frequent and serious complication following distal pancreatectomy. Various approaches, including different closure methods, transection devices, intestinal serosal patches, fibrin glue, and drainage procedures have been proposed as potential means of preventing POPF. 1 Polyglycolic acid (PGA) is a biodegradable thermoplastic polymer being used to facilitate wound healing in tissues ranging from oral mucosa and pleura to dura mater. Polyglycolic acid is hypothesized to induce inflammation and adhesion formation and through this mechanism prevent POPF. Previous case series evaluating the use of PGA mesh for preventing POPF are limited by the retrospective nature and the lack of standardized surgical technique. [2][3][4] Jang et al 5 performed a randomized clinical trial comparing distal pancreatic transection with a stapling device, fibrin glue application, and with and without additional stump wrapping with PGA mesh. The primary outcome was the incidence of clinically significant POPF, defined as International Study Group grade B or C. 6 Patient-related risk factors, such as age, body mass index, and pancreatic histology, were controlled through randomization. In comparison with the control group, the authors found that members of the intervention group who received PGA mesh demonstrated a significantly decreased incidence of clinically significant POPF (11.4% vs 28.3%, P = .04). 5 These results are compatible with 3 previous retrospective studies. 2,4,7 Postoperative pancreatic fistula is the Achilles heel of pancreatic surgery, and little progress has been made in addressing this problem. Although the International Study Group has

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Effect of Polyglycolic Acid Mesh for Prevention of Pancreatic Fistula Following Distal Pancreatectomy

Abstract: clinicaltrials.gov Identifier: NCT01550406.

Cited by 86 publications

References 26 publications

Network meta-analysis comparing techniques and outcomes of stump closure after distal pancreatectomy

Network meta-analysis comparing techniques and outcomes of stump closure after distal pancreatectomy

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

Polyglycolic Acid Mesh in Distal Pancreatectomy

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