The efficacy of polyglycolic acid felt to prevent the pancreatic fistula after distal pancreatectomy ∼A multicenter prospective cohort study∼

Abstract

Introduction: The pancreas fistula (PF) after distal pancreatectomy (DP) could be a fatal complication, and it is necessary to prevent. Various methods have been devised to prevent PF so far, but the optimal method has not yet been known. It has been proven by animal experiments that fibrin glue formulation interferes with tissue replacement of polyglycolic acid (PGA) felt which is usually used in combination with fibrin glue formulation. Therefore, we designed a multicenter prospective cohort study of remnant closure by stapling plus PGA felt patch after distal pancreatectomy. Method: 30 patients, scheduled for DP in our group, were prospectively enrolled, and received remnant closure by stapling plus PGA felt patch after DP. Four patients were unresected at laparotomy findings, and therefore 26 patients were undergone DP and analyzed the results. Result: Primary diseases were followed; 17 cases were pancreatic adenocarcinoma, 3 pancreatic neuroendocrine neoplasm, 2 mucinous cystic neoplasm, 2 solid pseudopapillary neoplasm, and 2 others. The mean diameter of main pancreatic duct at the excision site was 2.3 mm (1.0 to 10.0 mm), and the mean thickness of pancreatic parenchyma was 12.3 mm (7.3 to 24.5 mm). PF was found in 9 cases (34.6%) as biochemical leak, in 9 cases (33.9%) as grade B, and no case as grade C of ISGPF (2016). The mean postoperative drainage duration was 6 days (3 to 35 days), and the mean postoperative hospital stay was 16 days (9 to 40 days). Conclusion: The reduction of a fibrin glue formulation from PGA felt and standard stapled remnant closure did not increase the rate or severity of pancreatic fistula in patients undergoing distal pancreatectomy.