Prolonged peri-firing compression with a linear stapler prevents pancreatic fistula in laparoscopic distal pancreatectomy

2010 ◽  
Vol 25 (3) ◽  
pp. 867-871 ◽  
Author(s):  
Masafumi Nakamura ◽  
Junji Ueda ◽  
Hiroshi Kohno ◽  
Mohamed Yahia F. Aly ◽  
Shunichi Takahata ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy ◽  
Linear Stapler

scholarly journals Preventing clinically relevant pancreatic fistula with combination of linear stapling plus continuous suture of the stump in laparoscopic distal pancreatectomy

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Takeshi Aoki ◽  
Doaa A. Mansour ◽  
Tomotake Koizumi ◽  
Kazuhiro Matsuda ◽  
Tomokazu Kusano ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Laparoscopic Distal Pancreatectomy ◽  
Triple Combination ◽  
Continuous Suture ◽  
Remnant Pancreas ◽  
Stump Closure ◽  
Suture Group

Abstract Background Pancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity. The aim of our study is to compare linear stapling closure plus continuous suture with linear stapling closure alone during laparoscopic distal pancreatectomy (LDP) in terms of clinically relevant postoperative pancreatic fistula (POPF) rate. Methods Twenty-two patients underwent LDP at our institution between 2011 and 2013. Twelve patients had linear stapling closure with peri-firing compression (LSC) alone compared with ten patients who had linear stapling closure, peri-firing compression plus continuous suture (LSC/CS) for stump closure of remnant pancreas in LDP. Biochemical leak and clinically relevant POPF were compared between both groups. Results POPF occurred in 4 of 12 (33.3%) patients with linear stapling closure while no patient developed a clinically relevant POPF in the triple combination of linear stapling, peri-firing compression plus continuous suture group (p = 0.043).1 patient (8.3%) in the LSC group and 5 patients (50%) in the LSC/CS group had evidence of a biochemical leak. There were no significant differences in operative time (188.3 vs 187.0 min) and blood loss (135 vs. 240 g) between both groups but there was a significantly of shorter length of hospital stay (11.9 vs. 19.9 days) in LSC/CS group (p = 0.037). There was no mortality in either group. Conclusions The triple combination of linear stapling, peri-firing compression plus continuous suture in LDP has effectively prevented occurrence of clinically relevant ISGPF POPF. Trial registration The study was retrospectively registered September 30, 2019 at Showa University Ethics Committee as IRB protocol numbers 2943.

scholarly journals The rate of pancreatic fistula is not influenced by the size of stapler cartridge after laparoscopic distal pancreatectomy

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e402
Author(s):  
S. Dokmak ◽  
R. Meniconi ◽  
F.S. Ftériche ◽  
I. Duquesne ◽  
B. Aussilhou ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy

scholarly journals Fatal pancreatic fistula after laparoscopic distal pancreatectomy for intraductal papillary mucinous carcinoma with pancreaticobiliary maljunction and sphincterotomized papilla: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yoshifumi Morita ◽  
Tomohiro Akutsu ◽  
Mitsumasa Makino ◽  
Miku Obayashi ◽  
Shinya Ida ◽  
...  
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Coil Embolization ◽  
Laparoscopic Distal Pancreatectomy ◽  
Pancreaticobiliary Maljunction ◽  
Drainage Fluid ◽  
Abdominal Drain ◽  
Remnant Pancreas

Abstract Background Pancreatic juice is constantly activated by contaminated bile in patients with pancreaticobiliary maljunction (PBM). Here, we report a case of laparoscopic distal pancreatectomy for a patient with PBM and sphincterotomized papilla, resulting in fatal pancreatic fistula. Case presentation A 79-year-old man was diagnosed with pancreatic intraductal papillary mucinous neoplasm and common bile duct stones. Endoscopic sphincterotomy was performed prior to surgery. The pancreatic duct was simultaneously visualized when the contrast agent was injected into the common bile duct. Sudden bleeding was observed from the abdominal drain on postoperative day (POD) 6. Emergent stent graft placement and coil embolization were performed for bleeding from the splenic artery. On POD 9, the drainage fluid changed to yellowish in color with bile contamination. For internal drainage of the digestive fluid, endoscopic retrograde biliary tube and pancreatic drainage tube were placed. On POD 24, second emergent coil embolization was performed for bleeding from the left gastric artery. On POD 25, open abdominal drainage was performed. On POD 32, third emergent coil embolization was performed for bleeding from the gastroduodenal artery. Subsequently, remnant pancreatic resection was performed. On POD 39, massive bleeding was again observed from the abdominal drain. Emergency arterial portography revealed bleeding in the right wall of the superior mesenteric vein. The patient died of hemorrhagic shock on the same day. Conclusions The extreme risk of severe pancreatic fistula after distal pancreatectomy should be considered in patients with PBM and sphincterotomized papilla. In this extraordinary situation, surgeons should promptly decide whether to resect the remnant pancreas to prevent losing the patient.

scholarly journals The Use of Bovine Pericardial Buttress on Linear Stapler Fails to Reduce Pancreatic Fistula Incidence in a Porcine Pancreatic Transection Model

HPB Surgery ◽  
2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
A. Maciver ◽  
M. McCall ◽  
D. Mihalicz ◽  
D. Al-Adra ◽  
R. Pawlick ◽  
...  
Keyword(s):  
Pilot Study ◽  
Pancreatic Fistula ◽  
Laparoscopic Distal Pancreatectomy ◽  
Linear Stapler ◽  
Control Groups ◽  
Surgical Stapler ◽  
Surgical Model ◽  
Pancreatic Transection ◽  
Pancreatic Neck ◽  
And Control

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

scholarly journals Laparoscopic Distal Pancreatectomy : The Risk Of Pancreatic Fistula Is Mainly Related To The Drainage Modality

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e766
Author(s):  
S. Dokmak ◽  
B. Aussilhou ◽  
F.S. Ftériche ◽  
R. Chérif ◽  
L. Barbier ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Laparoscopic Distal Pancreatectomy
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