Decreasing pancreatic leak after distal pancreatectomy: bovine pericardium wrapping stump in a porcine model.

ABSTRACT

BACKGROUND: Despite marked improvements in pancreatic surgery, the high incidence and morbidity of pancreatic leak after resection has remained unchanged. The current study investigated the safety and efficacy of bovine pericardium wrapping stump after distal pancreatectomy in a porcine model. METHODS: Thirty-two swine were randomly assigned to control and experiment groups to undergo conventional scalpel transection with single hand-sewn closure of the pancreatic remnant (control) or bovine pericardium wrapping stump combined with hand-sewn closure (experiment). Closed-suction drainage was collected and measured daily. Animals were necropsied at 3 weeks postoperatively, and the pancreatic remnants were examined for histology. Primary end points were the development of a pancreatic fistula defined as greater than threefold drain/serum amylase after the 3rd postoperative day, and the presence of undrained amylase-rich fluid collections/abscess. RESULTS: The incidence of pancreatic leak in the wrapping group was 6.3 versus 46.7% in the control group (p < 0.05). The amount of drainage fluid was higher in the control group than the experiment group during the postoperative days. There were no differences in operative time or other clinical parameters measured. No other significant differences were found in macroscopic changes between groups at reexploration. Histological examination demonstrated focal, chronic inflammation with necrosis in all animals. CONCLUSIONS: Bovine pericardium wrapping stump effectively reduced the incidence of pancreatic leakage after the distal pancreatectomy.