The effect of mesh reinforcement of a stapled transection line on the rate of pancreatic occlusion failure after distal pancreatectomy: review of a single institution's experience.
BACKGROUND
Pancreatic occlusion failure (POF) after distal pancreatectomy remains a common source of morbidity. Here, we review our experience with distal pancreatectomy and attempt to identify factors which influence POF rates.


METHODS
One hundred sixty-nine distal pancreatectomies were performed between 2002 and 2007. Review of the computerized medical records and physician office records was performed for all patients. Univariate and multivariate analyses were performed to determine factors which might influence the incidence of POF. The data set was analysed for factors which might influence the pancreatic occlusion rate. Analysis included patient and disease characteristics including: age, gender, body mass index (BMI), diagnosis, consistency of the pancreas and history of pancreatitis, as well as intra-operative variables including: surgeon, absorbable mesh reinforcement and operative approach.


RESULTS
POF was the most common peri-operative complication. POF was identified in 32 out of 169 patients (19%). Transection technique (hand sewn, stapled, stapled with mesh) and procedure complexity were factors associated with differences in POF rates by both univariate and multivariate analyses. POF was identified in 7 out of 70 patients (10%) when an absorbable mesh was utilized, and 25 of 99 patients (25%) when mesh was not utilized (P < 0.02).


CONCLUSIONS
These data suggest that a randomized controlled trial will be required to determine if mesh reinforcement reduces the rate and severity of POF after distal pancreatectomy.
Johnston
Fabian Mc
FM
Washington University School of Medicine, Department of Surgery, Division of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, St. Louis, MO, USA.
Cavataio
Antonino
A
Strasberg
Steven M
SM
Hamilton
Nicholas A
NA
Simon
Peter O
PO
Trinkaus
Kathryn
K
Doyle
M B Majella
MB
Mathews
Brent D
BD
Porembka
Matthew R
MR
Linehan
David C
DC
Hawkins
William G
WG