title: Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  BACKGROUND
  Clinicaltrials.gov: NCT01359410.
authors.affiliation: Departments of Surgery, Washington University School of Medicine, Saint Louis, MO 63110, USA.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Hamilton
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Porembka
authors.forename: Fabian M
authors.initials: FM
authors.lastname: Johnston
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: David C
authors.initials: DC
authors.lastname: Linehan
authors.forename: William G
authors.initials: WG
authors.lastname: Hawkins
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D016037:Single-Blind Method; D013526:Surgical Mesh; D017792:Surgical Stapling