Preliminary Study on the Efficacy of Peritoneal Patch in Reducing the Incidence of Pancreatic Fistula after Pancreaticoduodenectomy

Abstract

Introduction: Several studies have already evaluated the efficacy of different devices in decreasing the incidence of POPF by reinforcing the pancreatic anastomosis after pancreaticoduodenectomy. Unfortunately, until now none of them have shown any clear benefits. Purpose: To evaluate a new technique to perform a pancreaticojejunostomy in pancreas at high risk for fistula. Method: From June 2020, a total of 10 patients out of 33 who underwent a pancreaticoduodenectomy for cancer at our institution were selected for this study. All of the selected patients were at high risk for pancreatic fistula due to soft pancreatic parenchyma and/or non dilated pancreatic duct. A pancreaticojejunostomy with Blumgart’s technique was performed in every case. A peritoneal patch was used to cover the surface of the pancreatic stump before the anastomosis in order to give a sealing effect and strengthen the suture. A pancreatic stent was always placed through the pancreatic duct. We assessed the rate of POPF (ISGPF definition) within 30 postoperative days. Results: In those patients treated by the use of a peritoneal patch no fistula was observed. All patients underwent a pre-discharge CT-scan at day 7 showing no abdominal collections or vascular pseudo-aneurysms. The peritoneal patch might improve the anastomosis healing by lowering the outflow of pancreatic juice from the parenchyma during the immediate post-operative days. Conclusion: Preliminary data about the application of a peritoneal patch are encouraging and it might prove a useful tool in preventing POPF and PPH.