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

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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.

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Authors and Affiliations

  1. Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashigh-ku, Tokyo, 173-8610, Japan

    Shintaro Yamazaki, Tadatoshi Takayama, Yusuke Mitsuka, Nao Yoshida, Naoki Yoshida, Naoaki Shimamoto & Tokio Higaki

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  1. Shintaro Yamazaki
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  2. Tadatoshi Takayama
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  3. Yusuke Mitsuka
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  4. Nao Yoshida
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  5. Naoki Yoshida
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  6. Naoaki Shimamoto
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  7. Tokio Higaki
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Correspondence to Tadatoshi Takayama.

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Yamazaki, S., Takayama, T., Mitsuka, Y. et al. Feasibility of Hyaluronate Carboxymethylcellulose-Based Bioresorbable Membrane in Two-Staged Pancreatojejunostomy. World J Surg 44, 902–909 (2020). https://doi.org/10.1007/s00268-019-05253-y

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  • DOI: https://doi.org/10.1007/s00268-019-05253-y

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