title: Increased incidence of pancreatic fistulas after the introduction of a bioabsorbable staple line reinforcement in distal pancreatic resections.
abstract: Pancreatic fistula is a major cause of morbidity after distal pancreatic resection. When resections are performed with linear stapling devices, the use of bioabsorbable staple line reinforcement has been suggested to decrease the rate of pancreatic fistula. Our objective was to investigate the incidence of pancreatic fistula when using the Gore Seamguard staple line reinforcement in stapled distal pancreatic resections. A retrospective review of 30 consecutive patients with stapled distal pancreatectomy was conducted. A broad definition of pancreatic fistula was used. Clinicopathologic factors and outcomes were compared between groups. Pancreatic fistula was diagnosed in 11 of 15 patients (73%) and three of 15 patients (20%) in the Seamguard and non-Seamguard groups, respectively (P = 0.002). Pancreatic parenchymal transection at the neck of the gland was associated with pancreatic fistula, whereas laparoscopic procedures, splenic preservation, or additional organ resection were not. On multivariate analysis, the association between Seamguard use and pancreatic fistula was significant (P = 0.005). In conclusion, after introduction of the Gore Seamguard bioabsorbable staple line reinforcement, we experienced a significant increase in the rate of pancreatic fistula. This experience raises concern about the efficacy of this device in limiting pancreatic fistula after stapled distal pancreatic resection.
authors.affiliation: Department of General Oncologic Surgery, City of Hope National Medical Center, Duarte, California 91010, USA.
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Guzman
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Nelson
authors.forename: Joseph
authors.initials: J
authors.lastname: Kim
authors.forename: Alessio
authors.initials: A
authors.lastname: Pigazzi
authors.forename: Vijay
authors.initials: V
authors.lastname: Trisal
authors.forename: Benjamin
authors.initials: B
authors.lastname: Paz
authors.forename: Joshua
authors.initials: J
authors.lastname: Di Ellenhorn
mesh_terms: D020341:Absorbable Implants / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004146:Dioxanes / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010185:Pancreatic Fistula / Q000453:epidemiology*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013526:Surgical Mesh / Q000009:adverse effects*; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004146:Dioxanes; C443643:trimethylene carbonate