Study On Polypropylene Mesh-reinforced Pancreaticojejunostomy: Results From An Animal Experiment

Objective To study the feasibility and possible advantage in preventing the pancreatic leakage of a new pancreaticojejunostomy------polypropylene mesh-reinforced pancreaticojejunostomy through an animal experiment.Methods The study was performed on ten Bama piglets undergoing the mesh-reinforced pancreaticojejunostomy. Preoperatively, The weight of every piglet was measured; Blood sample was collected for the analysis of serum amylase content and blood glucose level. Intraoperatively, Exam the pancreatic texture and shape; Measure the diameter of the main pancreatic duct; Record the anastomosis time and finally test the pressure of the pancreatic anatomosis. The piglets were raised for 90 days, during which the mental status, appetite, stool was observed; The quantity and the appearance of the fluid from the abdominal drainage was observed and the amylase content of the fluid was analyzed on 7th and 14th day after surgery respectively. On the 90th day postoperatively, The weight and the blood glucose level of each surviving piglet was measured again before killed; Reexploration was conducted for any signs of infection around the pancreatic anatomosis, the unity and healing of the pancreatic anatomosis, the texture change of the pancreas; The diameter of the main pancreatic ducts were measured again for comparison. The specimens of the pancreatic anastomoses were preserved for pathologic examination. All the measurement date involved were analyzed by t-test for the signicicant difference. Results The weight, serum amylase content and blood glucose level preoperative was 17.87±3.27kg,83.2±8.74mg/ml,814.2±98.23IU/L respectively. The pancreatic texture was soft and fragile and the pancreatic shape was slim and prolate. The diameter of the main pancreatic duct was 0.095±0.036 cm. All the ten piglets were performed the polypropylene mesh-reinforced pancreaticojejunostomy successfully. The mean anastomosis time was 23.3min. The pressure of the pancreatic anatomosis was> 90cmH2O in 9 piglets and< 90cmH2O in 1 piglet. During the raised period of 90 days,3 piglets were dead from mesenteric vascular thrombosis, bleeding of the pancreatic remnant and anesthetic accident respectively with no sign of pancreatic leakage observed at autopsy. Because of the poor submission of the piglets and the disappearance or obstruction of the abdominal drainage, we could only collect 5 piglets' fluid samples on 7th day and fail to collect any fluid on 14th after surgery. The amylase content from the abdominal drainage was 1571.6±512.45 IU/L, less than three times of the serum amylase content preoperative. After 90 days,7 piglets were alive with 5 weight gain and 2 weight loss. The blood glucose level was 94.9±11.10 mg/ml, with no significant rise compared to the preoperative level(P=0.543). When the piglets were killed and reexplored, Abdominal adhesion was observed to some extent;No blue stain, local fluid collection, pseudocyst or necrotic areas was observed. The pancreatic anastomosis was continuous and consistent with pancreatic texture shrinked and stiffened. The diameter of the main pancreatic ducts were dilated significant compared to the preoperative condition(P< 0.001). The mesh mingled with polypropylene suture was about to detach from the pancreatic remnant. The pathologic examination of the pancreatic anatomosis show:solid fibrous tissue linked up both side of the pancreatic anastomosis, the pancreatic remnant was covered with intestinal mucosa and hyperplastic fibrous tissue, the main pancreatic duct dilated with fibrous tissue hyperplasia around, the pancreatic parenchyma was atrophy and fibrosis.Conclusions The results from the animal experiment indicate that 1. Polypropylene mesh-reinforced pancreaticojejunostomy is feasible and easy performed. 2.The pancreatic anastomosis after polypropylene mesh-reinforced pancreaticojejunostomy heal up well with no pancreatic leakage observed.3. The pancreaticojejunostomy have the main pancreatic duct dilated to some extent, the parenchyma shrinked and stiffened, the endocrine and exocrine function deteriorated to some extent for the pancreatic remnant in this animal experiment.4.The mesh used in the experiment is rejected by the tissue.