Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2012 Jun;255(6):1037-42.
doi: 10.1097/SLA.0b013e31825659ef.

Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial

Nicholas A Hamilton  1 , Matthew R Porembka, Fabian M Johnston, Feng Gao, Steven M Strasberg, David C Linehan, William G Hawkins
Affiliations
Randomized Controlled Trial

Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial

Nicholas A Hamilton et al. Ann Surg. 2012 Jun.

Abstract

Introduction: Pancreatic leak or fistula is the most frequent complication after left pancreatectomy. We performed a single-blinded, parallel-group, randomized controlled trial comparing stapled left pancreatectomy with stapled left pancreatectomy using mesh reinforcement of the staple line with either Seamguard or Peristrips Dry.

Methods: All patients undergoing left pancreatectomy at a large tertiary hospital were eligible for participation. Patients were randomized to either mesh reinforcement or no-mesh reinforcement intraoperatively after being determined a candidate for resection. Patients were blinded to the result of their randomization for 6 weeks. Primary outcome measure was clinically significant leak as defined by the ISGPF (International Study Group on Pancreatic Fistula) pancreatic leak grading system.

Results: One hundred patients were randomized to either mesh (54) or no-mesh (46) reinforcement of their pancreatic transection. There was 1 death in each group. ISGPF grade B and C leaks were seen in 1.9% (1/53) of patients undergoing resection with mesh reinforcement and 20% (11/45) of patients without mesh reinforcement (P = .0007).

Conclusions: Mesh reinforcement of pancreatic transection line significantly reduces the incidence of significant pancreatic fistula in patients undergoing left pancreatectomy.

Trial registration: Clinicaltrials.gov: NCT01359410.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Criteria for Grading Pancreatic Fistula/Pancreatic Occlusion Failure
Figure 2
Figure 2
Randomization Flowchart
Figure 3
Figure 3
Odds Ratio for Developing Pancreatic Occlusion Failure by Risk Category
See this image and copyright information in PMC

Comment in

References

    1. Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg. 1999;229:693–700. - PMC - PubMed
    1. Rodriguez JR, Germes SS, Pandharipande PV, Gazelle GS, Thayer SP, Warshaw AL, et al. Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg. 2006;141:361–366. - PMC - PubMed
    1. Knaebel HP, Diener MK, Wenter MN, et al. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2005;92:539–46. - PubMed
    1. Yeo CJ, Cameron JL, Maher MM, et al. A prospective randomized trial of pancreaticogastrostomy versus pancreaticojejunostomy after pancreaticoduodenectomy. Ann Surg. 1995;222:580–92. - PMC - PubMed
    1. Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PWT. Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg. 2003;90:190–196. - PubMed

Publication types

Associated data