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Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis

Postoperative pancreatic fistula (POPF) is the most common and intractable complication after partial pancreatectomy, with an incidence of 13% to 64%. Polyglycolic acid (PGA) mesh is a new technique that is designed to prevent POPF, and its effect has been evaluated in several randomized controlled...

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Autores principales: Zhang, Wei, Wei, Zhicheng, Che, Xu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447380/
https://www.ncbi.nlm.nih.gov/pubmed/32846759
http://dx.doi.org/10.1097/MD.0000000000021456
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author Zhang, Wei
Wei, Zhicheng
Che, Xu
author_facet Zhang, Wei
Wei, Zhicheng
Che, Xu
author_sort Zhang, Wei
collection PubMed
description Postoperative pancreatic fistula (POPF) is the most common and intractable complication after partial pancreatectomy, with an incidence of 13% to 64%. Polyglycolic acid (PGA) mesh is a new technique that is designed to prevent POPF, and its effect has been evaluated in several randomized controlled trials and some retrospective cohort studies. In this study, we systematically and comprehensively analyzed the efficacy of PGA mesh based on reported studies. We searched Medline, Embase, and Cochrane Library databases in English between January 2010 and October 2019. Analysis was performed by using Review Manger 5.3 software. Three RCTs and 8 nonrandomized studies were eligible with a total of 1598 patients including 884 PGA group patients and 714 control group patients. For pancreatoduodenectomy (PD), distal pancreatectomy (DP), and the 2 partial pancreatectomy (PD or DP), we found significant statistical differences in overall POPF (relative risk [RR] = 0.75, 95% confidence interval [CI] = 0.61–0.91, P = .004; RR = 0.74, 95% CI = 0.57–0.96, P = .02; RR = 0.76, 95% CI = 0.64–0.89, P = .0009, respectively) and clinical pancreatic fistula (PF) (RR = 0.5, 95% CI = 0.37–0.68, P < .00001; RR = 0.31, 95% CI = 0.21–0.46, P < .00001; RR = 0.41, 95% CI = 0.32–0.52, P < .00001, respectively) in favor of PGA. For partial pancreatectomy, significant statistical differences were found in overall complications (RR = 0.77, 95% CI: 0.67–0.88, P = .0002) and estimated blood loss (weighted mean difference [WMD] = −53.58; 95% CI: −101.20 to −5.97, P = .03) in favor of PGA. We did not find significant differences regarding operative time (WMD = −8.86; 95% CI: −27.59 to 9.87, P = .35) and hospital stay (WMD = −2.73; 95% CI: −7.53 to 2.06, P = .26). This meta-analysis shows the benefits of the PGA mesh technique regarding POPF, clinical PF, and postoperative complications. This still needs to be verified by more randomized control trials.
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spelling pubmed-74473802020-09-04 Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis Zhang, Wei Wei, Zhicheng Che, Xu Medicine (Baltimore) 7100 Postoperative pancreatic fistula (POPF) is the most common and intractable complication after partial pancreatectomy, with an incidence of 13% to 64%. Polyglycolic acid (PGA) mesh is a new technique that is designed to prevent POPF, and its effect has been evaluated in several randomized controlled trials and some retrospective cohort studies. In this study, we systematically and comprehensively analyzed the efficacy of PGA mesh based on reported studies. We searched Medline, Embase, and Cochrane Library databases in English between January 2010 and October 2019. Analysis was performed by using Review Manger 5.3 software. Three RCTs and 8 nonrandomized studies were eligible with a total of 1598 patients including 884 PGA group patients and 714 control group patients. For pancreatoduodenectomy (PD), distal pancreatectomy (DP), and the 2 partial pancreatectomy (PD or DP), we found significant statistical differences in overall POPF (relative risk [RR] = 0.75, 95% confidence interval [CI] = 0.61–0.91, P = .004; RR = 0.74, 95% CI = 0.57–0.96, P = .02; RR = 0.76, 95% CI = 0.64–0.89, P = .0009, respectively) and clinical pancreatic fistula (PF) (RR = 0.5, 95% CI = 0.37–0.68, P < .00001; RR = 0.31, 95% CI = 0.21–0.46, P < .00001; RR = 0.41, 95% CI = 0.32–0.52, P < .00001, respectively) in favor of PGA. For partial pancreatectomy, significant statistical differences were found in overall complications (RR = 0.77, 95% CI: 0.67–0.88, P = .0002) and estimated blood loss (weighted mean difference [WMD] = −53.58; 95% CI: −101.20 to −5.97, P = .03) in favor of PGA. We did not find significant differences regarding operative time (WMD = −8.86; 95% CI: −27.59 to 9.87, P = .35) and hospital stay (WMD = −2.73; 95% CI: −7.53 to 2.06, P = .26). This meta-analysis shows the benefits of the PGA mesh technique regarding POPF, clinical PF, and postoperative complications. This still needs to be verified by more randomized control trials. Lippincott Williams & Wilkins 2020-08-21 /pmc/articles/PMC7447380/ /pubmed/32846759 http://dx.doi.org/10.1097/MD.0000000000021456 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0
spellingShingle 7100
Zhang, Wei
Wei, Zhicheng
Che, Xu
Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis
title Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis
title_full Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis
title_fullStr Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis
title_full_unstemmed Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis
title_short Effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: A systematic review and meta-analysis
title_sort effect of polyglycolic acid mesh for prevention of pancreatic fistula after pancreatectomy: a systematic review and meta-analysis
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447380/
https://www.ncbi.nlm.nih.gov/pubmed/32846759
http://dx.doi.org/10.1097/MD.0000000000021456
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