Simplicity and Safety: Minimized Pancreatic Fistula Rate after Distal Pancreatectomy through Pancreas Stump Sutured Fish-Mouth Closure

2018 ◽  
Vol 84 (11) ◽  
pp. 1734-1740
Author(s):  
Michael J. Minarich ◽  
Roderich E. Schwarz
Keyword(s):  
Length Of Stay ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Surgical Oncology ◽  
Postoperative Recovery ◽  
Splenic Vessel ◽  
Pancreatic Stump ◽  
Fistula Rate ◽  
Oncology Practice ◽  
Pancreatic Fistula Rate

Pancreatic stump leak after distal pancreatectomy (DP) is a major determinant for impaired postoperative recovery. Factors influencing pancreatic fistula (PF) occurrence remain of interest. Prospectively collected data from an academic surgical oncology practice were examined for predictors of PF. Seventy-five of 294 pancreatectomy patients underwent DP (26%). There were 33 men and 42 women, with a median age of 61 years (range: 18–85 years). Underlying conditions included cancer (60%) and benign processes (40%). Resections were comprising open DP (64%), laparoscopic DP (21%), and open multivisceral resections (15%). Of 21 cases with postoperative complications (28%, no death), six were PFs (8%, 2 grade A and 4 grade B). The median length of stay was six days (4–24). The PF rate was 2.0 per cent in 50 patients after sutured fish-mouth closures, but 20 per cent in cases using other techniques including stapling ( P = 0.007); no other variable was linked to PF occurrence. Length of stay was linked to complications, resection extent, malignancy, and transfusions (all at P < 0.02), but not to PF. PF rate after DP in this experience is unaffected by splenic vessel resection but seems to be minimized through a sutured fish-mouth closure technique.

Outcomes after Distal Pancreatectomy for Trauma in the Modern Era

2016 ◽  
Vol 82 (6) ◽  
pp. 526-532 ◽  
Author(s):  
Gregory L. Peck ◽  
David N. Blitzer ◽  
Constantine S. Bulauitan ◽  
Lauren A. Huntress ◽  
Paul Truche ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Early Death ◽  
Outcome Data ◽  
Trauma Patients ◽  
Pancreatic Stump ◽  
Fibrin Sealants ◽  
Stump Closure ◽  
Pancreatic Injuries ◽  
Fistula Rate

Multiple stump closure techniques after distal pancreatectomy (DP) for trauma have been described, and all are associated with a significant fistula rate. With increasing emphasis on abbreviated laparotomy, stapled pancreatectomy has become more common. This study describes the outcomes of patients with different closure techniques of the pancreatic stump after resection following pancreatic trauma. Retrospective analysis of 50 trauma patients, who sustained grade III pancreatic injuries with subsequent DP and stapled stump closure, were conducted from 1995 to 2011. Demographic, operative, and outcome data were analyzed to characterize patients, and to directly compare closure techniques. After 12 patients were excluded because of early death (<72 hours), final analyses included 38 patients: 19 (50%) had stapled closure alone and 19 (50%) had stapling with adjunct, including additional closure with sutures, fibrin sealants, or a combination of sutures with fibrin sealants/omental coverage. Twenty-four patients (63%) had postoperative complications, most commonly pancreatic fistula (n = 11, 29%). There were no significant differences with regard to pancreatic fistula or other abdominal complications between closure groups, or were any factors associated with increased likelihood of complications. DP remains a morbid operation after trauma regardless of closure technique. Stapled closure alone is perhaps the method of choice in this setting due to the time constraints directly related to outcomes.

Central versus Distal Pancreatectomy for Benign or Low-Grade Malignant Lesions in the Pancreatic Neck and Proximal Body

2019 ◽  
Vol 85 (11) ◽  
pp. 1239-1245 ◽  
Author(s):  
Yangjun Li ◽  
Yujie Li
Keyword(s):  
Confidence Interval ◽  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Low Grade ◽  
Exocrine Insufficiency ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

The purpose of this meta-analysis was to compare the clinical outcomes of central pancreatectomy (CP) with distal pancreatectomy (DP). PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2018. A meta-analysis was performed to compare the clinical outcomes of CP versus DP. Nineteen trials with 1440 patients were analyzed. Although there were no significant differences in the rate of intra-operative blood transfusion between two groups, CP costs more operative time as well as had more intraoperative blood loss than DP. Furthermore, the overall complication rate, pancreatic fistula rate, and the clinically significant pancreatic fistula rate were significantly higher in the CP group. On the other hand, CP had a lower risk of endocrine (odds ratio: 0.17; 95% confidence interval: 0.10, 0.29; P < 0.05) and exocrine insufficiency (odds ratio: 0.22; 95% confidence interval: 0.10, 0.48; P < 0.05). CP was associated with a higher pancreatic fistula rate, and it should be performed in selected patients who need preservation of the pancreas, which is of utmost importance.

Novel Method of Stump Closure for Distal Pancreatectomy with a 75% Reduction in Pancreatic Fistula Rate

2011 ◽  
Vol 16 (3) ◽  
pp. 524-528 ◽  
Author(s):  
Joseph A. Blansfield ◽  
Megan M. Rapp ◽  
Ravi J. Chokshi ◽  
Nicole L. Woll ◽  
Marie A. Hunsinger ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Stump Closure ◽  
Novel Method ◽  
Fistula Rate ◽  
Pancreatic Fistula Rate

scholarly journals Wrapping the pancreas with a polyglycolic acid sheet before stapling reduces the risk of fluid collection on the pancreatic stump after distal pancreatectomy

2021 ◽  
Author(s):  
Ji Su Kim ◽  
Seoung Yoon Rho ◽  
Dong Min Shin ◽  
Munseok Choi ◽  
Chang Moo Kang ◽  
...  
Keyword(s):  
Pancreatic Fistula ◽  
Distal Pancreatectomy ◽  
Fluid Collection ◽  
International Study ◽  
Polyglycolic Acid ◽  
Previous Method ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital ◽  
Pancreatic Stump ◽  
Resection Line

Abstract Background Postoperative pancreatic fistula (POPF) and postoperative fluid collection (POFC) are common complications after distal pancreatectomy (DP). The previous method of reducing the risk of POPF was the application of a polyglycolic acid (PGA) sheet to the pancreatic stump after cutting the pancreas with a stapler (After-stapling); the new method involves wrapping the pancreatic resection line with a PGA sheet before stapling (Before-stapling). The study aimed to compare the incidence of POPF and POFC between two methods. Methods Data of patients who underwent open or laparoscopic DPs by a single surgeon from October 2010 to February 2020 in a tertiary referral hospital were retrospectively analyzed. POPF was defined according to the updated International Study Group of Pancreatic Fistula criteria. POFC was measured by postoperative computed tomography (CT). Results Altogether, 182 patients were enrolled (After-stapling group, n = 138; Before-stapling group, n = 44). Clinicopathologic and intraoperative findings between the two groups were similar. Clinically relevant POPF rates were similar between both groups (4.3% vs. 4.5%, p = 0.989). POFC was significantly lesser in the Before-stapling group on postoperative day 7 (p < 0.001). Conclusions Wrapping the pancreas with PGA sheet before stapling was a simple and effective way to reduce POFC.

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