Polyglycolic Acid Mesh and Fibrin Glue in Minimally Invasive Left Pancreatectomy: Video Technique and Single-Center Data.

Abstract

Postoperative pancreatic fistula (POPF) remains a major challenge after left pancreatectomy (LP).^1-3 While polyglycolic acid (PGA) mesh wrapping has been shown to reduce clinically relevant (CR-)POPF in open LP,⁴ its efficacy in minimally invasive LP (MILP) remains unvalidated. This study evaluates the effectiveness of PGA mesh and fibrin glue reinforcement during MILP in a single-center retrospective cohort. We analyzed 148 patients who underwent MILP from 2020 to 2023 (115 laparoscopic LP and 33 robotic LP). Pancreatic transection was performed using a bioabsorbable reinforcement-attached stapler in all cases. Short-term outcomes were compared between 25 patients in the PGA-wrapping group and 123 in the control group. PGA-wrapping reinforcement required a median of 3.8 min (range 2.4-7.2 min), with no significant difference in operative time between groups. CR-POPF incidence (grade B or higher) was significantly lower in the PGA-wrapping group (20% vs. 44%, p = 0.024), with shorter time to drain removal (3 vs. 5 days, p < 0.001) and hospital stay (p = 0.002). Readmission rates were comparable (4% versus 7%, p = 0.590). Multivariate analysis identified PGA-wrapping as an independent protective factor for CR-POPF (p = 0.032). PGA mesh wrapping of the pancreatic stump is a feasible and effective technique that significantly reduces CR-POPF rates without increasing morbidity in MILP.