Pancreatic neck thickness: A possible key to stump closure technique selection after distal pancreatectomy

Abstract Background To date, no stump closure technique has been shown to be superior in lowering the risk of postoperative pancreatic fistula (POPF) after pancreatectomy. The aims our study were to investigate the possibility to influence POPF risk by selection of stump closure technique according to pancreatic parenchyma thickness and to establish a thickness cut-off value for selection of a hand-sewn and stapled closure technique. Methods A retrospective analysis of consecutive patients who underwent distal pancreatectomy at a single centre was performed. Anatomical determination of the transection site (pancreatic neck, body, or tail) was based on operative report and postoperative follow-up computed tomography (CT), with the thickness measured on the most recent CT image before surgery. Patients were classified by the thickness of the transection site, and sub-classified according to stump closure technique. POPF incidence, morbidity, mortality, and baseline-characteristics were investigated between groups. Results Among the 115 cases included in the analysis, the incidence of POPF was 33%, with no difference between stapled (29.9%) and hand-sewn (37.5%) closure techniques (p=0.426), regardless of transection site thickness. Among those with a transection site <13 mm, the incidence of POPF was 4.6% in the stapler subgroup versus 45.5% in the hand-sewn subgroup (p=0.0002). Among patients with a transection site ≥13 mm, the incidence of POPF was 75% in the stapler subgroup versus 30.8% in the hand-sewn subgroup (p=0.007). Conclusions Transection in the pancreatic neck, stapler closure of thin parenchyma, and hand-sewn closure of thick parenchyma were associated with significantly lower risk of POPF.

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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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The rate of postoperative pancreatic fistula after distal pancreatectomy is independent of the pancreatic stump closure technique – A retrospective analysis of 284 cases

Asian Journal of Surgery ◽

10.1016/j.asjsur.2019.03.009 ◽

2020 ◽

Vol 43 (1) ◽

pp. 227-233 ◽

Cited By ~ 4

Author(s):

S. Chikhladze ◽

F. Makowiec ◽

S. Küsters ◽

H. Riediger ◽

O. Sick ◽

...

Keyword(s):

Pancreatic Fistula ◽

Retrospective Analysis ◽

Distal Pancreatectomy ◽

Postoperative Pancreatic Fistula ◽

Closure Technique ◽

Pancreatic Stump ◽

Stump Closure

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Tu1789 Pancreas Stump Closure Technique Affects Pancreatic Fistula Rate After Radical Distal Pancreatectomy

Gastroenterology ◽

10.1016/s0016-5085(15)34038-5 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-1183

Author(s):

Roderich E. Schwarz

Keyword(s):

Pancreatic Fistula ◽

Distal Pancreatectomy ◽

Closure Technique ◽

Stump Closure ◽

Fistula Rate ◽

Pancreatic Fistula Rate

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

BMC Surgery ◽

10.1186/s12893-020-00876-8 ◽

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.

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