PPF method may prevent pancreatic fistula after distal pancreatectomy: study

In accordance with previous reports on the utility of polyethene glycolic acid (PGA) felt and fibrin glue for postoperative pancreatic fistula (POPF), we usually perform distal pancreatectomy (DP) with a PGA felt reinforcement stapler when dissecting the pancreas and cover the stump with PGA felt and fibrin glue (the PPF method). In this study, they retrospectively analyzed their distal pancreatectomy cases to compare the risk factors for postoperative pancreatic fistula and the postoperative course of patients receiving the PPF method of treatment versus that those receiving conventional treatment.

A total of 127 DP procedures performed in our department between January 2008 and June 2021 were retrospectively analysed.

The results of the study are:

• In the PPF method, grade B/C postoperative pancreatic fistula rate tended to decrease, and POPF rate showed a significant decrease.
• The duration of drainage and the length of postoperative hospitalisation were also significantly shorter with the PPF method.
• The risk of grade B/C postoperative pancreatic fistula significantly decreased with the PPF method if the pancreas was thick (> 13.5 mm) or the patients were obese.

Thus, the PPF method is useful for POPF in distal pancreatectomy and is particularly effective when a thick pancreas or obese patient is involved. Removing the drainage tube early in the PPF method may lead to early discharge.

Reference:

Kawasaki, K., Hayashi, T., Takahashi, M. et al. Covering reinforced staples with polyethylene glycolic acid felt-covered fibrin sealant to prevent pancreatic fistula after distal pancreatomy: a retrospective comparative study. BMC Surg 22, 349 (2022). https://doi.org/10.1186/s12893-022-01799-2

Keywords:

Keishi Kawasaki, Tatsuya Hayashi, Makoto Takahashi, Yasuhiro Morita, BMC Surgery, Postoperative pancreatic fistula, Distal pancreatectomy, Polyethylene glycolic acid felt, Fibrin glue