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Maki Yamamoto, MD; Michael S. Hayashi, MD; Ninh T. Nguyen, MD; Thang D. Nguyen, MD; Scott McCloud, CRT, RDMS; David K. Imagawa, MD, PhD

Arch Surg. 2009;144(10):894-899.

Objective  To investigate the use of Seamguard, a bioabsorbable staple line–reinforcement product, to prevent pancreatic leak after distal pancreatectomy.

Design, Setting, and Participants  A retrospective study examined 85 consecutive patients undergoing distal pancreatectomy at an academic institution from September 5, 1997, to September 30, 2007.

Main Outcome Measures  Pancreatic fistula and overall mortality and morbidity.

Results  In February 2004, the use of Seamguard in distal pancreas resections was introduced at our institution. Indications for resection included trauma (11 patients), neoplasms (62 patients), and chronic pancreatitis (12 patients). Pancreatic leak was defined as drain output of 25 mL/d or more 7 days postoperatively with a drain amylase level of 1000 U/L or more. Pancreatic leak occurred in 10 of 38 patients (26%) undergoing conventional resection with suture ligation of the pancreatic duct or nonreinforced stapled resection vs 2 of 47 patients (4%) undergoing staple resection using Seamguard reinforcement. Multivariate analysis showed that use of Seamguard with the stapler independently decreased the risk for pancreatic fistula after distal pancreatectomy (odds ratio, 0.07; 95% confidence interval, 0.01-0.43; P = .01).

Conclusions  The use of Seamguard is quickly becoming a common adjunct in distal pancreas resections. Our study shows a lower incidence of pancreatic leak after distal pancreatectomy with the use of this staple line–reinforcing product.

Author Affiliations: Departments of Surgery (Drs Yamamoto, Hayashi, N. T. Nguyen, T. D. Nguyen, and Imagawa), and Radiological Sciences (Mr McCloud), and Divisions of Gastrointestinal and Laparoscopic Surgery (Dr N. T. Nguyen) and Hepatobiliary and Pancreas Surgery, Islet Cell Transplantation (Drs T. D. Nguyen and Imagawa), University of California–Irvine Medical Center, Orange.

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To Mesh or Not to Mesh, That Is the Question: Comment on "Use of Seamguard to Prevent Pancreatic Leak Following Distal Pancreatectomy"
William G. Hawkins
Arch Surg. 2009;144(10):899.
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