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World J Surg (2016) 40:27712781 DOI 10.1007/s00268-016-3612-0
http://crossmark.crossref.org/dialog/?doi=10.1007/s00268-016-3612-0&domain=pdf
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Web End = ORIGINAL SCIENTIFIC REPORT
Autologous but not Fibrin Sealant Patches for Stump Coverage Reduce Clinically Relevant Pancreatic Fistula in Distal Pancreatectomy: A Systematic Review and Meta-analysis
Maximilian Weniger1 Jan Goesta DHaese1 Alexander Crispin2
Martin Kurt Angele1 Jens Werner1 Werner Hartwig1
Published online: 24 June 2016 Socit Internationale de Chirurgie 2016
AbstractBackground Postoperative pancreatic stula (POPF) causes signicant morbidity and mortality after distal pancreatectomy. Patch coverage of the pancreatic stump is often used with the intention to prevent POPF. Despite numerous investigations, the effects of patch coverage remain unclear. The present meta-analysis aims to clarify the effects of patch coverage in distal pancreatectomy on the incidence of POPF.
Methods A systematic search of MEDLINE/PubMed and the Cochrane Database according to the PRISMA Statement was performed. Subsequently a meta-analysis on rates and overall incidence of POPF and length of hospital stay was carried out. By applying the inverse variance weighting method, the combined effect size and 95 % condence interval were calculated. Heterogeneity was assessed using I2 statistics.
Results Five randomized controlled trials and six observational clinical studies were included for nal analysis. A cumulative incidence of 43 % of POPF grades AC was identied. Patch coverage in distal pancreatectomy is signicantly associated with a decreased rate of POPF grade C (p = 0.006). Patches of autologous vascularized tissue signicantly reduce the overall incidence of POPF (p = 0.04) and clinically relevant POPF grade B and C (p = 0.002). Fibrin sealant patches do not inuence rates of POPF after distal pancreatectomy. None of the outcomes evaluated showed adverse results for the patch group.
Conclusions Patch coverage after distal pancreatectomy can reduce the rate of POPF. Patch coverage with autologous vascularized tissue but not brin sealant patches may be used to reduce clinically relevant POPF and postoperative morbidity in distal pancreatectomy.
AbbreviationsBMI Body mass indexCI Condence intervalIPMN Intraductal papillary mucinous neoplasm LOS Length of postoperative hospital stay
Maximilian Weniger and Jan Goesta DHaese have contributed equally.
Electronic supplementary material The online version of this article (doi:http://dx.doi.org/10.1007/s00268-016-3612-0
Web End =10.1007/s00268-016-3612-0 ) contains supplementary material, which is available to authorized users.
& Werner Hartwig [email protected]
Maximilian Weniger [email protected]
Jan Goesta DHaese [email protected]
Alexander Crispin [email protected]