The Use of Bovine Pericardial Buttress on Linear Stapler Fails to Reduce Pancreatic Fistula Incidence in a Porcine Pancreatic Transection Model

Abstract EN

We investigate the effectiveness of buttressing the surgical stapler to reduce postoperative pancreatic fistulae in a porcine model.

As a pilot study, pigs (n=6) underwent laparoscopic distal pancreatectomy using a standard stapler.

Daily drain output and lipase were measured postoperative day 5 and 14.

In a second study, pancreatic transection was performed to occlude the proximal and distal duct at the pancreatic neck using a standard stapler (n=6), or stapler with bovine pericardial strip buttress (n=6).

Results.

In pilot study, 3/6 animals had drain lipase greater than 3x serum on day 14.

In the second series, drain volumes were not significantly different between buttressed and control groups on day 5 (55.3 ± 31.6 and 29.3 ± 14.2 cc, resp.), nor on day 14 (9.5 ± 4.2 cc and 2.5 ± 0.8 cc, resp., P=0.13).

Drain lipase was not statistically significant on day 5 (3,166 ± 1,433 and 6,063 ± 1,872 U/L, resp., P=0.25) or day 14 (924 ± 541 and 360 ± 250 U/L).

By definition, 3/6 developed pancreatic fistula; only one (control) demonstrating a contained collection arising from the staple line.

Conclusion.

Buttressed stapler failed to protect against pancreatic fistula in this rigorous surgical model.