Journal of Gastrointestinal Surgery

, Volume 11, Issue 1, pp 59–65 | Cite as

Absorbable Mesh Reinforcement of a Stapled Pancreatic Transection Line Reduces the Leak Rate with Distal Pancreatectomy

  • Reuben I. Thaker
  • Brent D. Matthews
  • David C. Linehan
  • Steven M. Strasberg
  • J. Chris Eagon
  • William G. Hawkins


Pancreatic leak remains a significant cause of morbidity after distal pancreatectomy. We report the use of an absorbable mesh to reinforce a stapled pancreatic transection line for distal pancreatectomy. Forty consecutive distal pancreatectomies (33 open and 7 laparoscopic) were performed since the introduction of mesh reinforcement. We utilized an inclusive definition of pancreatic leak to critically evaluate the staple line reinforcement material. In addition, we compared the pancreatic leak rate for this case series with the antecedent 40 cases where mesh reinforcement was not available. In the prospective series there was 1 leak in 29 cases (3.5%) in which mesh reinforcement was utilized, and 4 leaks in 11 cases (36%) when mesh was not utilized (p < 0.005). The 12.5% leak rate for the 40 cases during the prospective period, compared favorably to the 27.5% leak rate for the 40 cases preceding the study period (p = 0.09). Twenty-nine cases receiving mesh compared favorably to the 23 stapled cases in the control series, reducing leak rate from 22 to 3.5% (p = 0.04). Mesh reinforcement of the stapled pancreatic transection line reduced the pancreatic leak rate after distal pancreatectomy. Mesh reinforcement was possible with open or laparoscopic resections. No complications were attributable to the use of absorbable mesh.


Distal pancreatectomy Mesh reinforcement SeamGuard Pancreatic leak Pancreatic fistula 


  1. 1.
    Balcom JH, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: Changing indications, older patients, and decreasing length of hospitalization. Arch Surg 2001;136(4):391–398.PubMedCrossRefGoogle Scholar
  2. 2.
    Brennan MF, Moccia RD, Klimstra D. Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 1996;223(5):506–511.PubMedCrossRefGoogle Scholar
  3. 3.
    Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005;92(5):539–546.PubMedCrossRefGoogle Scholar
  4. 4.
    Mori T, Abe N, Sugiyama M, Atomi Y. Laparoscopic hepatobiliary and pancreatic surgery: An overview. J Hepatobiliary Pancreat Surg 2002;9(6):710–722.PubMedCrossRefGoogle Scholar
  5. 5.
    Sperti C, Pasquali C, Liessi G, Pinciroli L, Decet G, Pedrazzoli S. Pancreatic resection for metastatic tumors to the pancreas. J Surg Oncol 2003;83(3):161–166.PubMedCrossRefGoogle Scholar
  6. 6.
    Bassi C, Butturini G, Molinari E, Mascetta G, Salvia R, Falconi M, Gumbs A, Pederzoli P. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg 2004;21(1):54–59.PubMedCrossRefGoogle Scholar
  7. 7.
    Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002;183(3):237–241.PubMedCrossRefGoogle Scholar
  8. 8.
    Pratt W, Maithel S, Vanounou T, Huang Z, Callery M, Vollmer C. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISPGF) classification scheme. HPB 2006;8(Suppl 1):24.Google Scholar
  9. 9.
    Farkas G, Leindler L, Farkas G, Jr. Safe closure technique for distal pancreatic resection. Langenbecks Arch Surg 2005;390(1):29–31.PubMedCrossRefGoogle Scholar
  10. 10.
    Fernandez-del Castillo C, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg 1995;130(3):295–299.PubMedGoogle Scholar
  11. 11.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J. et al. Postoperative pancreatic fistula: An International Study Group (ISGPF) Definition. Surgery 2005;138(1):8–13.PubMedCrossRefGoogle Scholar
  12. 12.
    Bruce J, Krukowski ZH, Al Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg 2001;88(9):1157–1168.PubMedCrossRefGoogle Scholar
  13. 13.
    Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW. Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 2003;90(2):190–196.PubMedCrossRefGoogle Scholar
  14. 14.
    Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: Indications and outcomes in 235 patients. Ann Surg 1999;229(5):693–698.PubMedCrossRefGoogle Scholar
  15. 15.
    Suzuki Y, Fujino Y, Tanioka Y, Hori Y, Ueda T, Takeyama Y, Tominaga M, Ku Y, Yamamoto YM, Kuroda Y. Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg 1999;86(5):608–611.PubMedCrossRefGoogle Scholar
  16. 16.
    Wagner M, Dikopoulos N, Kulli C, Friess H, Buchler MW. Standard surgical treatment in pancreatic cancer. Ann Oncol 1999;10(Suppl 4):247–251.PubMedCrossRefGoogle Scholar
  17. 17.
    Lansing PB, Browder IW, Harkness SO, Kitahama A. Staple closure of the pancreas. Am Surg 1983;49(4):214–217.PubMedGoogle Scholar
  18. 18.
    Pachter HL, Pennington R, Chassin J, Spencer F. Simplified distal pancreatectomy with the auto suture stapler: Preliminary clinical observations. Surgery 1979;85(2):166–170.PubMedGoogle Scholar
  19. 19.
    Gyurko G, Czehelnik R. Closure of wounds of the stomach and pancreas with tissue adhesive and autoplastic peritoneum patch: An experimental study. Am Surg 1971;37(12)761–764.PubMedGoogle Scholar
  20. 20.
    Kajiyama Y, Tsurumaru M, Udagawa H, Tsutsumi K, Kinoshita Y, Akiyama H. Quick and simple distal pancreatectomy using the GIA stapler: Report of 35 cases. Br J Surg 1996;83(12):1711.PubMedGoogle Scholar
  21. 21.
    Ohwada S, Ogawa T, Tanahashi Y, Nakamura S, Takeyoshi I, Ohya T, Ikeya T, Kawashima K, Kawashima Y, Morishita Y. Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg 1998;22(5):494–498.PubMedCrossRefGoogle Scholar
  22. 22.
    Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, Campbell KA, Choti MA. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg 2000;232(3):419–429.PubMedCrossRefGoogle Scholar
  23. 23.
    Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N. Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 2001;234(4):487–493.PubMedCrossRefGoogle Scholar
  24. 24.
    Consten E, Gagner M, Milone L, Bardaro S. Reducing pancreatic duck leak and hemorrhage during laparoscopic distal pancreatectomy and partial splenectomy using staple line reinforcement with an absorbable polymer membrane. HPB 2006;6(Suppl 1):34.Google Scholar
  25. 25.
    Consten EC, Gagner M, Pomp A, Inabnet WB. Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg 2004;14(10):1360–1366.PubMedCrossRefGoogle Scholar
  26. 26.
    De la Torre RA, Scott JS. Laparoscopic Roux-en-Y gastric bypass: A totally intra-abdominal approach—technique and preliminary report. Obes Surg 1999;9(5):492–498.PubMedCrossRefGoogle Scholar
  27. 27.
    Roberson LD, Netherland DE, Dhillon R, Heath BJ. Air leaks after surgical stapling in lung resection: A comparison between stapling alone and stapling with staple-line reinforcement materials in a canine model. J Thorac Cardiovasc Surg 1998;116(2):353–354.PubMedCrossRefGoogle Scholar
  28. 28.
    Vaughn CC, Wolner E, Dahan M, Grunenwald D, Vaughn CC, III, Klepetko W, Klepetko W, Filaire M, Vaughn PL, Baratz RA. Prevention of air leaks after pulmonary wedge resection. Ann Thorac Surg 1997;63(3):864–866.PubMedCrossRefGoogle Scholar
  29. 29.
    Consten EC, Gagner M. Perioperative outcome of laparoscopic left lateral liver resection is improved by using staple line reinforcement technique: A case report. J Gastrointest Gurg 2005;9(3):360–364.CrossRefGoogle Scholar
  30. 30.
    Franklin ME, Jr, Berghoff KE, Arellano PP, Trevino JM, Abrego-Medina D. Safety and efficacy of the use of bioabsorbable SeamGuard in colorectal surgery at the Texas Endosurgery Institute. Surg Laparosc Endosc Percutan Tech 2005;15(1):9–13.PubMedCrossRefGoogle Scholar
  31. 31.
    Katz AR, Mukherjee DP, Kaganov AL, Gordon S. A new synthetic monofilament absorbable suture made from polytrimethylene carbonate. Surg Gynecol Obstet 1985;161(3):213–222.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Reuben I. Thaker
    • 1
  • Brent D. Matthews
    • 1
  • David C. Linehan
    • 1
    • 2
  • Steven M. Strasberg
    • 1
    • 2
  • J. Chris Eagon
    • 1
  • William G. Hawkins
    • 1
    • 2
  1. 1.Department of Surgery, Division of Hepatobiliary, Pancreatic, and Gastrointestinal SurgeryWashington University School of MedicineSt LouisUSA
  2. 2.Siteman Cancer CenterSt. LouisUSA

Personalised recommendations