Impact of Pancreatic Stump Wrapping with Mesh on Post-Operative Pancreatic Fistula in Patients Undergoing Distal/Left Pancreatectomy for Malignant or Benign Diseases: A Systematic Review and Meta-Analysis.

Background and

Objectives

Post-Operative Pancreatic Fistula (POPF) is reported among 13% to 64% of cases following a distal/left pancreatectomy (D/LP). Many efforts aim to prevent the onset of POPF or reduce its clinical impact. This meta-analysis sought to provide data by assessing POPF rates among patients undergoing D/LP for benign or malignant pancreatic diseases, with or without pancreatic stump mesh wrapping. Materials and

Methods

We undertook a systematic review following the PRISMA guidelines, alongside the Cochrane Handbook for Systematic Reviews of Interventions. We evaluated the certainty in the evidence using the GRADE approach for the following key outcomes: overall POPF and clinically relevant POPF. PubMed/MEDLINE, Web of Science, and Scopus were employed to retrieve relevant papers. Pooled analysis was carried out employing RevMan Version 5.4.1.

Results

Among the 8 comparative studies considered (1042 subjects: 430 Wrapping Mesh Group (WMG) versus 612 control group (CG)), seven were retrospective observational studies and one was a randomized controlled trial. Polyglycolic acid (PGA) mesh was used in 7 studies, except for one, who used a polyglactin mesh. Regarding the primary outcomes, meta-analysis showed lower rates of Overall POPF (Ov-POPF) (OR: 0.57, 95% CI: 0.37, 0.88; p = 0.01) and clinically relevant POPF (CR-POPF) (OR: 0.33, 95% CI: 0.21, 0.50; p < 0.00001) in the WMG. Moreover, the WMG also showed a decrease in Estimated Blood Loss (EBL) (MD: -43.11, 95%, CI: -63.20, -23.02, p < 0.0001), a shorter period with surgical drain (MD: -9.66, 95% CI: -17.99, -1.34, p = 0.02) and a decreased length of hospital stay (MD: -4.60, 95%, CI: -7.83, -1.36, p = 0.005).

Conclusions

Our meta-analysis showed that wrapping the pancreatic stump with mesh is associated with lower rates of overall POPF and clinically relevant POPF, lower EBL, a shorter period with the surgical drain and reduced hospital stay duration. There is a need for high-quality methodological research to identify the risk factors for the onset of POPF and to evaluate and compare the results of various surgical approaches used to reduce its rate and associated morbidity.