Pancreato-jejunostomy versus hand-sewn closure of the pancreatic stump to prevent pancreatic fistula after distal pancreatectomy: a retrospective analysis

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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PATCH-DP: A single-arm phase II trial of intra-operative application of HEMOPATCH™ to the pancreatic stump to prevent post-operative pancreatic fistula following distal pancreatectomy

HPB ◽

10.1016/j.hpb.2021.05.007 ◽

2021 ◽

Author(s):

Lev D. Bubis ◽

Ramy Behman ◽

Rachel Roke ◽

Pablo E. Serrano ◽

Jad Abou Khalil ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Phase Ii ◽

Phase Ii Trial ◽

Pancreatic Stump

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Outcomes after Distal Pancreatectomy for Trauma in the Modern Era

The American Surgeon ◽

10.1177/000313481608200614 ◽

2016 ◽

Vol 82 (6) ◽

pp. 526-532 ◽

Cited By ~ 1

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.

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The relationship with the stapler closure of pancreatic stump and postoperative pancreatic fistula after distal pancreatectomy

HPB ◽

10.1016/j.hpb.2018.06.2281 ◽

2018 ◽

Vol 20 ◽

pp. S655

Author(s):

M. Tani ◽

H. Maehira ◽

H. Iida ◽

N. Kitamura ◽

H. Mori ◽

...

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Postoperative Pancreatic Fistula ◽

Pancreatic Stump ◽

The Relationship

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Irrigation and passive drainage of pancreatic stump after distal pancreatectomy in high-risk patients: an innovative approach to reduce pancreatic fistula

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-02012-9 ◽

2020 ◽

Vol 405 (8) ◽

pp. 1233-1241

Author(s):

Olga Adamenko ◽

Carlo Ferrari ◽

Jan Schmidt

Keyword(s):

High Risk ◽

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Surgical Complication ◽

Fluid Collection ◽

Ringer Solution ◽

Pancreatic Stump ◽

High Risk Patients ◽

Risk Patients ◽

Drain Amylase

Abstract Introduction Postoperative pancreatic fistula (POPF) represents the most common form of morbidity after distal pancreatectomy (DP). The aim of this study was to illustrate an innovative technique of irrigation and passive drainage to reduce clinically relevant POPF (CR-POPF) incidence in high-risk patients undergoing DP. Material and methods Twelve consecutive high-risk patients received irrigation and passive drainage of the pancreatic stump with a Salem sump drainage after DP. The Salem sump was irrigated with 100 ml/h of Ringer solution for 2 postoperative days (POD). In the case of low-drain amylase and lipase levels on POD 3, the irrigation was reduced to 50 ml/h. Persistence of low-drain pancreatic enzymes on POD 4 allowed for interruption of irrigation and subsequent removal of drainage from POD 7 onward in the absence of evidence of any pancreatic fistula. Results Overall, 16.6% of the patients experienced a grade 3 or higher surgical complication. We experienced only one case of POPF: the fistula was classified as grade B and it was managed with radiologic drainage of the fluid collection. We did not experience any case of re-operation nor in-hospital mortality. Conclusions Irrigation with passive drainage of the pancreatic stump after DP is an interesting approach for CR-POPF prevention in high-risk patients.

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

The American Surgeon ◽

10.1177/000313481808401127 ◽

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.

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