The use of bovine pericardial buttress on linear stapler fails to reduce pancreatic fistula incidence in a porcine pancreatic transection model

Abstract

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±14.2cc, resp.), nor on day 14 (9.5±4.2cc and 2.5±0.8cc, resp., P = 0.13). Drain lipase was not statistically significant on day 5 (3,166±1,433 and 6,063±1,872U/L, resp., P = 0.25) or day 14 (924±541 and 360±250U/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. Copyright © 2011 A. Maciver et al.