title: Prevention of pancreatic fistula using polyethylene glycolic acid mesh reinforcement around pancreatojejunostomy: the propensity score-matched analysis.
abstract: BACKGROUND
  Several small-scale studies have shown that wrapping polyethylene glycolic acid (PGA) mesh around the anastomotic site reinforced pancreaticojejunostomy following pancreatoduodenectomy (PD) with favorable outcomes. This study investigated the efficacy of PGA mesh for reducing postoperative pancreatic fistula (POPF) and evaluated other risk factors for POPF.
  
  
  METHODS
  This study enrolled 464 consecutive patients who underwent PD performed by one surgeon between 2006 and 2015, including a PGA group of 281 patients (60.6%) and a control group of 183 patients (39.4%). All pancreatico-enteric anastomoses were performed using double-layered, duct-to-mucosa, end-to-side pancreaticojejunostomy.
  
  
  RESULTS
  Mean patient age was 63.1 years. The rates of overall (27.0% vs. 37.2%, P = 0.024) and clinically relevant (Grades B, C; 13.9% vs. 24.0%, P = 0.006) POPF were significantly lower in the PGA than in the control group. Following propensity score matching, the rates of clinically relevant POPF (12.6% vs. 22.4%, P = 0.024) and complications (40.2% vs. 63.8%, P < 0.001) remained significantly lower in the PGA group. Multivariate analysis showed that non-pancreatic disease, greater blood loss, higher body mass index, and non-application of PGA mesh were significantly associated with the development of clinically relevant POPF.
  
  
  CONCLUSIONS
  PGA mesh reinforcement of pancreaticojejunostomy may prevent POPF as well as reducing overall abdominal complications after PD.
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Jae Seung
authors.initials: JS
authors.lastname: Kang
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Youngmin
authors.initials: Y
authors.lastname: Han
authors.affiliation: Department of Surgery, Dongguk University College of Medicine, Ilsan, Korea.
authors.forename: Hongbeom
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Wooil
authors.initials: W
authors.lastname: Kwon
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Chongno-gu, Seoul, 110-744, Korea.
authors.forename: Jin-Young
authors.initials: JY
authors.lastname: Jang
mesh_terms: D000714:Anastomosis, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000517:prevention & control*; D010193:Pancreaticojejunostomy; D011100:Polyglycolic Acid / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000517:prevention & control*; D057216:Propensity Score; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome
chemical_list: D011100:Polyglycolic Acid
keywords: Pancreatic fistula; Pancreatoduodenectomy; Polyethylene glycolic acid; Surgical mesh