Advertisement

Feasibility of Hyaluronate Carboxymethylcellulose-Based Bioresorbable Membrane in Two-Staged Pancreatojejunostomy

  • Shintaro Yamazaki
  • Tadatoshi TakayamaEmail author
  • Yusuke Mitsuka
  • Nao Yoshida
  • Naoki Yoshida
  • Naoaki Shimamoto
  • Tokio Higaki
Original Scientific Report

Abstract

Background

Two-staged pancreatoduodenectomy with exteriorization of pancreatic juice is a safe procedure for high-risk patients. However, two-staged pancreatoduodenectomy requires complex re-laparotomy and adhesion removal. We analyzed whether using hyaluronate carboxymethylcellulose-based bioresorbable membrane (HCM) reduced the time required for the second operation and facilitated good fistula formation in two-staged pancreatoduodenectomy.

Methods

Between April 2011 and December 2018, data were collected from 206 consecutive patients who underwent two-staged pancreatoduodenectomy. HCM has been used for all patients since 2015. Patients for whom HCM was used (HCM group; n = 61) were compared to historical controls (before 2015) without HCM (control group; n = 145) in terms of feasibility of the second operation (operation time, adhesion grade, and complications) and optimal granulation around the external tube at the second laparotomy.

Results

The HCM group showed significantly shorter median operation time [105 min (30–228 min) vs. 151 min (30–331 min); p < 0.001] and smaller median blood loss [36 mL (8–118 mL) vs. 58 mL (12–355 mL); p < 0.001] for the second operation. Neither overall postoperative complication rate (p = 0.811) nor severe-grade complication rate (p = 0.857) differed significantly. Both groups showed good fistula formation, with no significant difference in rate of optimal fistula formation (HCM group, 95.1% vs. control, 95.9%; p = 0.867).

Conclusion

HCM placement significantly improved safety and duration for the second operation, while preserving good fistula formation.

Notes

Funding

Nothing to report.

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

References

  1. 1.
    Coleman MG, McLain AD, Moran BJ (2000) Impact of previous surgery on time taken for incision and division of adhesions during laparotomy. Dis Colon Rectum 43(9):1297–1299CrossRefGoogle Scholar
  2. 2.
    Hayashi S, Takayama T, Masuda H et al (2008) Bioresorbable membrane to reduce postoperative small bowel obstruction in patients with gastric cancer: a randomized clinical trial. Ann Surg. 247(5):766–770CrossRefGoogle Scholar
  3. 3.
    Kawamura H, Yokota R, Yokota K et al (2010) A sodium hyaluronate carboxymethylcellulose bioresorbable membrane prevents postoperative small-bowel adhesive obstruction after distal gastrectomy. Surg Today 40(3):223–227CrossRefGoogle Scholar
  4. 4.
    Hashimoto D, Hirota M, Yagi Y et al (2012) Hyaluronate carboxymethylcellulose-based bioresorbable membrane (Seprafilm) reduces adhesion under the incision to make unplanned re-laparotomy safer. Surg Today 42(9):863–867CrossRefGoogle Scholar
  5. 5.
    Inoue M, Uchida K, Miki C et al (2005) Efficacy of Seprafilm for reducing reoperative risk in pediatric surgical patients undergoing abdominal surgery. J Pediatr Surg 40(8):1301–1306CrossRefGoogle Scholar
  6. 6.
    Tang CL, Seow-Choen F, Fook-Chong S et al (2003) Bioresorbable adhesion barrier facilitates early closure of the defunctioning ileostomy after rectal excision: a prospective, randomized trial. Dis Colon Rectum 46(9):1200–1207CrossRefGoogle Scholar
  7. 7.
    Salum M, Wexner SD, Nogueras JJ et al (2006) Does sodium hyaluronate- and carboxymethylcellulose-based bioresorbable membrane (Seprafilm) decrease operative time for loop ileostomy closure? Tech Coloproctol 10(3):187–190CrossRefGoogle Scholar
  8. 8.
    Dupré A, Lefranc A, Buc E et al (2013) Use of bioresorbable membranes to reduce abdominal and perihepatic adhesions in 2-stage hepatectomy of liver metastases from colorectal cancer: results of a prospective, randomized controlled phase II trial. Ann Surg 258(1):30–36CrossRefGoogle Scholar
  9. 9.
    Shimizu A, Hasegawa K, Masuda K et al (2018) Efficacy of hyaluronic acid/carboxymethyl cellulose-based bioresorbable membranes in reducing perihepatic adhesion formation: a prospective cohort study. Dig Surg 35(2):95–103CrossRefGoogle Scholar
  10. 10.
    Seyama Y, Kubota K, Kobayashi T et al (1998) Two-staged pancreatoduodenectomy with external drainage of pancreatic juice and omental graft technique. J Am Coll Surg 187(1):103–105CrossRefGoogle Scholar
  11. 11.
    Hasegawa K, Kokudo N, Sano K et al (2008) Two-stage pancreatojejunostomy in pancreaticoduodenectomy: a retrospective analysis of short-term results. Am J Surg. 196(1):3–10CrossRefGoogle Scholar
  12. 12.
    Aoki T, Sakamoto Y, Kohno Y et al (2018) Hepatopancreaticoduodenectomy for Biliary Cancer: Strategies for Near-zero Operative Mortality and Acceptable Long-term Outcome. Ann Surg 267(2):332–337CrossRefGoogle Scholar
  13. 13.
    Callery MP, Pratt WB, Kent TS et al (2013) A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg 216(1):1–14CrossRefGoogle Scholar
  14. 14.
    Mungroop TH, Klompmaker S, Wellner UF et al (2019) Updated alternative fistula risk score (ua-FRS) to include minimally invasive pancreatoduodenectomy: pan-European validation. Ann Surg. Feb 13 in press.Google Scholar
  15. 15.
    Kakita A, Takahashi T, Yoshida M et al (1996) A simpler and more reliable technique of pancreatojejunal anastomosis. Surg Today 26(7):532–535CrossRefGoogle Scholar
  16. 16.
    Zühlke HV, Lorenz EM, Straub EM, et al. (1990) Pathophysiology and classification of adhesions. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1009–1016.Google Scholar
  17. 17.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefGoogle Scholar
  18. 18.
    Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group of Pancreatic Surgery (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 161(3):584–591CrossRefGoogle Scholar
  19. 19.
    Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 142(1):20–25CrossRefGoogle Scholar
  20. 20.
    Uchida K, Urata H, Mohri Y et al (2005) Seprafilm does not aggravate intraperitoneal septic conditions or evoke systemic inflammatory response. Surg Today 35(12):1054–1059CrossRefGoogle Scholar
  21. 21.
    Meng G, Xing Q, Yuan Q et al (2014) Internal compared with external drainage of pancreatic duct during pancreaticoduodenectomy: a retrospective study. Chin J Cancer Res 26(3):277–284PubMedPubMedCentralGoogle Scholar
  22. 22.
    Liu FB, Chen JM, Geng W et al (2015) Pancreaticogastrostomy is associated with significantly less pancreatic fistula than pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta-analysis of seven randomized controlled trials. HPB (Oxford). 17(2):123–130CrossRefGoogle Scholar
  23. 23.
    Schindl M, Függer R, Götzinger P et al (2018) Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy. Br J Surg 105(7):811–819CrossRefGoogle Scholar
  24. 24.
    Kojima T, Niguma T, Watanabe N et al (2018) Modified Blumgart anastomosis with the "complete packing method" reduces the incidence of pancreatic fistula and complications after resection of the head of the pancreas. Am J Surg 216(5):941–948CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Shintaro Yamazaki
    • 1
  • Tadatoshi Takayama
    • 1
    Email author
  • Yusuke Mitsuka
    • 1
  • Nao Yoshida
    • 1
  • Naoki Yoshida
    • 1
  • Naoaki Shimamoto
    • 1
  • Tokio Higaki
    • 1
  1. 1.Department of Digestive SurgeryNihon University School of MedicineTokyoJapan

Personalised recommendations