Effect of different pancreatic stump closure techniques after distal pancreatectomy on frequency and severity of acute postoperative pancreatitis

Objective: to study the effect of different pancreatic stump closure techniques and diameter of the main pancreatic duct on frequency and severity of acute postoperative pancreatitis after distal pancreatectomy. Material and Methods. Distal pancreatectomy was performed on 126 patients with neoplasms of body and/or tail of the pancreas. Patients were distributed among four groups based upon the pancreatic stump closure technique applied after distal pancreatectomy: group 1 (control) included the patients with isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing by the gastrocolic omentum or hemostatic sponge; group 2 patients underwent isolated suturing of the main pancreatic duct in the pancreatic stump with its subsequent sealing with 2-octyl cyanoacrylate biological glue; group 3 patients had their pancreatic stump closure performed with endoscopic linear cutter stapler; group 4 was composed of the patients with external transduodenal transnasal drainage of enlarged (D>3 mm) main pancreatic duct in the pancreatic stump. Results. The occurrence of acute postoperative pancreatitis in the control group amounted to 45.8%, while, in groups 2, 3 and 4, the frequencies were 44.4, 9.7 and 15.0(%), correspondingly. Besides, the control group was characterized by declined occurrence of the moderately severe form of acute postoperative pancreatitis. Use of endoscopic linear cutter stapler and external transduodenal transnasal drainage of the enlarged main pancreatic duct caused lower acute postoperative pancreatitis frequency in the patients with main pancreatic duct in their pancreatic stumps below 5 mm in diameter. Conclusion. Use of proposed pancreatic stump closure techniques after distal pancreatectomy resulted in lower frequencies of occurrence and severity of acute postoperative pancreatitis.

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THE DEPENDENCE OF DIRECT RESULTS OF DISTAL PANCREATECTOMIES ON DIFFERENT PANCREATIC STUMP CLOSURE TECHNIQUES

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2018-177-4-23-27 ◽

2018 ◽

Vol 177 (4) ◽

pp. 23-27

Author(s):

S. E. Voskanyan ◽

E. V. Naydenov ◽

I. Yu. Uteshev ◽

A. I. Artemiev ◽

Yu. D. Udalov ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Pancreatic Duct ◽

Postoperative Period ◽

Main Pancreatic Duct ◽

Postoperative Hospital Stay ◽

Control Group ◽

Pancreatic Stump ◽

Stump Closure ◽

Pancreatic Fistulas

The OBJECTIVE is to study the effect of application of different pancreatic stump closure techniques to the postoperative period, the frequency and severity of postoperative complications including postoperative pancreatic fistulas after distal pancreatectomies. MATERIAL AND METHODS. The clinical material consisted of 126 patients who underwent distal pancreatectomies (isolated or in combination with surgical interventions on the adjacent organs of the abdominal cavity and retroperitoneal space). The patients were divided into 4 groups depending on the pancreatic stump closure techniques (isolated suturing of the main pancreatic duct of the pancreatic stump with its omentization by gastrocolic omentum or local sealing its by hemostatic sponge (control group); using a local biological glue 2-octylcyanoacrylate; using the Endoscopic Linear Cutter Echelon; external transduodenal transnasal drainage of the enlarged main pancreatic duct of the pancreatic stump). We evaluated the influence of different pancreatic stump closure techniques after distal pancreatectomies on the postoperative period as well the frequency and severity of postoperative pancreatic fistulas depending on the diameter of the main pancreatic duct of pancreatic stump. RESULTS. The overall rate of postoperative complications in the control group of patients was 45.8 %, and was due to an increase in the frequency of specific complications (35.4 %). The most frequent complication in the control group of patients was postoperative pancreatic fistulas – 29.2 %. The statistically significant decrease of frequency and severity of postoperative complications, frequency and severity of postoperative pancreatic fistulas and decrease of postoperative hospital-stay after the application of the proposed different pancreatic stump closure techniques were revealed in comparison with the control group of patients. There was no hospital mortality. CONCLUSION. Distal pancreatectomy with «standard» pancreatic stump closure techniques accompanied by high frequency and severity of postoperative complications, as well as postoperative pancreatic fistulas. The use of the proposed pancreatic stump closure techniques after distal pancreatectomy led to a decrease of the frequency and severity of postoperative complications, a decrease of the frequency and severity of postoperative pancreatic fistulas, and a decrease of the postoperative hospital-stay.

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Clip Ligation of pancreatic duct and associated suturing of pancreas – The novel CLASP technique for pancreatic stump closure following distal pancreatectomy

HPB ◽

10.1016/j.hpb.2018.06.1848 ◽

2018 ◽

Vol 20 ◽

pp. S840

Author(s):

M. Papoulas ◽

E. Kontis ◽

A. Dolcet ◽

N. Heaton ◽

K. Menon

Keyword(s):

Pancreatic Duct ◽

Distal Pancreatectomy ◽

The Novel ◽

Pancreatic Stump ◽

Stump Closure

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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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Pancreatic neuroendocrine tumor featuring growth into the main pancreatic duct and tumor thrombus within the splenic vein: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa155 ◽

2020 ◽

Vol 2020 (7) ◽

Author(s):

Takashi Miyata ◽

Hiroyuki Takamura ◽

Ryosuke Kin ◽

Hisashi Nishiki ◽

Akifumi Hashimoto ◽

...

Keyword(s):

Neuroendocrine Tumor ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Splenic Vein ◽

Pancreatic Neuroendocrine Tumor ◽

Ductal Adenocarcinoma ◽

Pathological Examination ◽

Left Edge ◽

Pancreatic Stump ◽

Pancreatic Body

Abstract A 48-year-old woman was admitted to our hospital because of upper abdominal pain. Computer tomography showed an enhancing mass in the pancreatic body, dilation of the main pancreatic duct (MPD) and a filling defect within the splenic vein. On the basis of the preoperative diagnosis of pancreatic body cancer, distal pancreatectomy was scheduled. The pancreas was divided along the left edge of the gastroduodenal artery; however, frozen pathological examination of the pancreatic stump was tumor positive, and therefore a total pancreatectomy was performed. The lesion was a white expansive nodular mass that had spread into the MPD and protruded into the splenic vein. A pathological diagnosis of non-functioning neuroendocrine tumor (NET) was made. In general, imaging findings of disruption of the MPD and tumor vein thrombus are characteristics of pancreatic ductal adenocarcinoma, but are uncommon in NET. However, NET should be included in the differential diagnosis for such patients.

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Mo1504 Does Pancreatic Stump Closure Method Influence Fistula Rate After Distal Pancreatectomy

Gastroenterology ◽

10.1016/s0016-5085(12)64195-x ◽

2012 ◽

Vol 142 (5) ◽

pp. S-1080 ◽

Cited By ~ 1

Author(s):

Eugene P. Ceppa ◽

Robert M. McCurdy ◽

Molly Kilbane ◽

Attila Nakeeb ◽

C. Max Schmidt ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Pancreatic Stump ◽

Stump Closure ◽

Fistula Rate ◽

Closure Method

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A novel pancreatic stump closure technique with trans-pancreatic mattress suture using Vicryl mesh during distal pancreatectomy

Pancreatology ◽

10.1016/j.pan.2016.06.292 ◽

2016 ◽

Vol 16 (4) ◽

pp. S81-S82

Author(s):

Ippei Matsumoto ◽

Masataka Matsumoto ◽

Takaaki Murase ◽

Keiko Kamei ◽

Shumpei Satoi ◽

...

Keyword(s):

Distal Pancreatectomy ◽

Closure Technique ◽

Mattress Suture ◽

Pancreatic Stump ◽

Stump Closure ◽

Vicryl Mesh

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Distal Pancreatectomy: Clinically Relevant Leakage From the Pancreatic Stump Closure May Be Due to Drain Failure or Backpressure

Gastroenterology ◽

10.1016/s0016-5085(11)64239-x ◽

2011 ◽

Vol 140 (5) ◽

pp. S-1020

Author(s):

Yasushi Hashimoto ◽

L. William Traverso

Keyword(s):

Distal Pancreatectomy ◽

Pancreatic Stump ◽

Stump Closure

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Pancreatic fistula risk assessment after distal pancreatectomy: a retrospective controlled study

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2021-28-2-33-45 ◽

2021 ◽

Vol 28 (2) ◽

pp. 33-45

Author(s):

E. S. Drozdov ◽

E. B. Topolnitskiy ◽

S. S. Klokov ◽

T. V. Dibina

Keyword(s):

Risk Factors ◽

Pancreatic Fistula ◽

Pancreatic Duct ◽

Distal Pancreatectomy ◽

Main Pancreatic Duct ◽

Postoperative Pancreatic Fistula ◽

Controlled Study ◽

Morphological Examination ◽

Distal Pancreatic Resection ◽

Duct Diameter

Background. Despite declining mortality, postoperative pancreatic fistula (PPF) remains a common complication of distal pancreatic resection surgery challenging to clinical prediction.Objectives. Prognostic analysis of the postoperative pancreatic fistula risk factors in patients with previous distal pancreatectomy.Methods. A retrospective controlled assay enrolled 107 patients, including 63 (58.9%) male and 44 (41.1%) female patients. All patients underwent distal pancreatectomy followed by a morphological examination of resected material. All patients had a general and biochemical blood panel profiling. Pancreatic tissue density at a putative resection zone was assessed with computed tomography. The patients were allocated to two cohorts: (1) not developing PPF (77 patients) and (2) having postoperative PPF complications (30 patients.Results. No statistically significant differences by age, gender, ASA and BMI scores were observed in study cohorts. Multivariate analysis revealed a statistically significant correlation of the PPF rate with the following factors: main pancreatic duct diameter <3 mm (odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01–1.05, p = 0.01), pancreatic density at putative resection zone <30 HU in CT (OR 3.18, 95% CI 1.38–7.74, p < 0.01) and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L (OR 3.13, 95% CI 1.19–8.24, p < 0.01).Conclusion. A main pancreatic duct diameter <3 mm, pancreatic density at putative resection zone <30 HU in CT and differential albumin of postoperative day 1 vs. pre-surgery >14 g/L are independent risk factors of postoperative fistulae.

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Article Commentary: Management of Left Pancreatic Trauma

The American Surgeon ◽

10.1177/000313481107700102 ◽

2011 ◽

Vol 77 (1) ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Brice Malgras ◽

Richard Douard ◽

Nathalie Siauve ◽

Philippe Wind

Keyword(s):

Pancreatic Duct ◽

Distal Pancreatectomy ◽

Main Pancreatic Duct ◽

Emergency Laparotomy ◽

Trauma Patients ◽

Diagnostic Modality ◽

Spleen Preserving ◽

Endoscopic Techniques ◽

Pancreatic Duct Stenting ◽

Pancreatic Fistulas

Left pancreatic traumas (LPTs) are rare but serious lesions occurring in 1 to 6 per cent of abdominal trauma patients and mainly resulting from blunt traumas. LPT severity is primarily dependent on the associated injuries and secondarily related to main pancreatic duct injury responsible for complications: acute pancreatitis, pseudocysts, pancreatic fistulas, or abscesses. The guidelines for blunt LPT management can be presented as follows. In case of emergency laparotomy, pancreas exploration is mandatory to detect pancreatic duct lesions. In the absence of main pancreatic duct lesions, simple drainage is advocated. In case of distal injury to the main pancreatic duct, a left pancreatectomy is mandatory. In the absence of initial laparotomy, the diagnosis is more and more based on CT and magnetic resonance cholangiopancreatography, which tend to replace endoscopic retrograde cholangiopancreatography (ERCP) as a first-intent diagnostic modality. In case of distal injury to the main pancreatic duct, spleen-preserving distal pancreatectomy is recommended. In the absence of main pancreatic duct lesions, nonoperative treatment is advocated. When LPTs are discovered at the time of complications, pancreatic fistulas and/or pseudocysts are associated with main pancreatic lesions, which can be treated by pancreatic duct stenting at ERCP and/or internal endoscopic cystogastrostomy. However, in such cases, spleen-preserving distal pancreatectomy remains the treatment of choice. Pancreatic ductal lesions resulting from LPT have to be diagnosed early to avoid late complications. Distal pancreatectomy remains the treatment of choice in case of severe pancreatic ductal lesions because the role of ERCP stenting and endoscopic techniques needs further evaluation.

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