LOCAL COVERAGE OF THE PANCREATIC STUMP WITH AN NHS-PEG PATCH AND AN OMENTAL FLAP AND THE RISK OF CLINICALLY RELEVANT POSTOPERATIVE PANCREATIC FISTULA AFTER DISTAL PANCREATECTOMY
DOI:
https://doi.org/10.11603/1811-2471.2026.v.i2.16408Keywords:
distal pancreatectomy, postoperative pancreatic fistula, CR-POPF, ISGPS, NHS-PEG, Hemopatch, omentoplasty, CT morphometrics, complication prevention, length of hospital stayAbstract
SUMMARY. The aim – to evaluate the effectiveness of a combined local surgical prophylaxis – an NHS-PEG patch combined with coverage of the pancreatic stump using a vascularized omental flap – in reducing the incidence of clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy.
Material and Methods. A retrospective single-center cohort study was performed. The analysis included 138 patients who underwent distal pancreatic resection: 47 patients in the intervention group (local prophylaxis) and 91 patients in a historical control cohort. The primary endpoint was the incidence of CR-POPF (grades B/C according to ISGPS-2016); biochemical leak (grade A) was excluded. Secondary endpoints included postoperative pancreatic fistula of any grade, postoperative hemorrhage, relaparotomy, in-hospital mortality, and length of hospital stay. Preoperative CT morphometry (pancreatic parenchymal density in HU, main pancreatic duct diameter, and duct-to-parenchyma ratio in ventrodorsal and craniocaudal planes) was used for risk stratification. Statistical analyses employed the Mann–Whitney U test for continuous variables and Fisher’s exact test for categorical variables; relative risk (RR), absolute risk reduction (ARR), and number needed to treat (NNT) were calculated.
Results. Baseline characteristics were comparable between groups, including age (53 vs 55 years), BMI (24.4 vs 24.9 kg/m²), and CT parameters (pancreatic density 29.1 vs 29.2 HU; main pancreatic duct diameter 3.0 vs 3.0 mm). Postoperative pancreatic fistula of any grade occurred in 10.6 % (5/47) of patients in the prophylaxis group and 17.6 % (16/91) in the control group (RR 0.61; p=0.41). CR-POPF developed in 4.3 % (2/47) versus 12.1 % (11/91), respectively (RR 0.35; p=0.22), corresponding to an ARR of 7.8 % and an NNT of 12.8. All CR-POPF cases in the prophylaxis group were grade B; no grade C fistulas were observed, whereas grade C occurred in 4.4 % (4/91) of controls. Median length of hospital stay was significantly shorter in the prophylaxis group–11 days (IQR 8.5–13.0) versus 14 days (IQR 11.0–19.5) in controls (p<0.001). No significant differences were observed in postoperative hemorrhage, relaparotomy, or in-hospital mortality.
Conclusions. Combined local prophylaxis using an NHS-PEG patch and a vascularized omental flap after distal pancreatectomy was associated with a lower incidence of CR-POPF, absence of the most severe (grade C) fistulas, and a significantly reduced length of hospital stay. Prospective multicenter studies are warranted to confirm these findings and to define optimal indications.
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