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Background <p>Postoperative pancreatic fistula (POPF) remains a major challenge after left pancreatectomy (LP).<sup><CitationRef AdditionalCitationIDS="CR2" CitationID="CR1">1</CitationRef>–<CitationRef CitationID="CR3">3</CitationRef></sup> While polyglycolic acid (PGA) mesh wrapping has been shown to reduce clinically relevant (CR-)POPF in open LP,<sup><CitationRef CitationID="CR4">4</CitationRef></sup> its efficacy in minimally invasive LP (MILP) remains unvalidated. This study evaluates the effectiveness of PGA mesh and fibrin glue reinforcement during MILP in a single-center retrospective cohort.</p> Patients and Methods <p>We analyzed 148 patients who underwent MILP from 2020 to 2023 (115 laparoscopic LP and 33 robotic LP). Pancreatic transection was performed using a bioabsorbable reinforcement-attached stapler in all cases. Short-term outcomes were compared between 25 patients in the PGA-wrapping group and 123 in the control group.</p> Results <p>PGA-wrapping reinforcement required a median of 3.8 min (range 2.4–7.2&#xa0;min), with no significant difference in operative time between groups. CR-POPF incidence (grade B or higher) was significantly lower in the PGA-wrapping group (20% vs. 44%, <i>p</i> = 0.024), with shorter time to drain removal (3 vs. 5 days, <i>p</i> &lt; 0.001) and hospital stay (<i>p</i> = 0.002). Readmission rates were comparable (4% versus 7%, <i>p</i> = 0.590). Multivariate analysis identified PGA-wrapping as an independent protective factor for CR-POPF (<i>p</i> = 0.032).</p> Conclusions <p>PGA mesh wrapping of the pancreatic stump is a feasible and effective technique that significantly reduces CR-POPF rates without increasing morbidity in MILP.</p>

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Polyglycolic Acid Mesh and Fibrin Glue in Minimally Invasive Left Pancreatectomy: Video Technique and Single-Center Data

  • 期刊论文

  • 发表日期：

    2025年4月1日

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  • Hayato Baba,
  • Atsushi Oba,
  • Aya Maekawa,
  • Sho Kiritani,
  • Hiroshi Kobayashi,
  • Atsushi Takahashi,
  • Kojiro Omiya,
  • Kosuke Kobayashi,
  • Yoshihiro Ono,
  • Takafumi Sato,
  • Hiromichi Ito,
  • Yosuke Inoue,
  • Yu Takahashi

摘要

Background

Postoperative pancreatic fistula (POPF) remains a major challenge after left pancreatectomy (LP).1–3 While polyglycolic acid (PGA) mesh wrapping has been shown to reduce clinically relevant (CR-)POPF in open LP,4 its efficacy in minimally invasive LP (MILP) remains unvalidated. This study evaluates the effectiveness of PGA mesh and fibrin glue reinforcement during MILP in a single-center retrospective cohort.

Patients and Methods

We analyzed 148 patients who underwent MILP from 2020 to 2023 (115 laparoscopic LP and 33 robotic LP). Pancreatic transection was performed using a bioabsorbable reinforcement-attached stapler in all cases. Short-term outcomes were compared between 25 patients in the PGA-wrapping group and 123 in the control group.

Results

PGA-wrapping reinforcement required a median of 3.8 min (range 2.4–7.2 min), with no significant difference in operative time between groups. CR-POPF incidence (grade B or higher) was significantly lower in the PGA-wrapping group (20% vs. 44%, p = 0.024), with shorter time to drain removal (3 vs. 5 days, p < 0.001) and hospital stay (p = 0.002). Readmission rates were comparable (4% versus 7%, p = 0.590). Multivariate analysis identified PGA-wrapping as an independent protective factor for CR-POPF (p = 0.032).

Conclusions

PGA mesh wrapping of the pancreatic stump is a feasible and effective technique that significantly reduces CR-POPF rates without increasing morbidity in MILP.