A novel technique for pancreatic stump closure following distal pancreatectomy – The CLASP technique

Abstract

Introduction: Pancreatic fistula (PF) remains the primary source of morbidity following distal pancreatectomy (DP). There is currently no optimal stump closure technique to reduce pancreatic fistula rates. Methods: Presentation of a novel technique for pancreatic stump closure using Clip Ligation of the duct and Associated Suturing of Pancreas (CLASP). Retrospective study of the clinicopathological data and outcome of five patients that underwent distal pancreatectomy and splenectomy (DPS) using the CLASP technique. Results: Five patients with a median age of 65 underwent distal pancreatectomy splenectomy for pancreatic body or tail tumour using the CLASP technique. Four of those operations were done laparoscopically. Only one patient developed grade A PF. No other postoperative complications were noticed. The mean length of stay was 5.4 days. CLASP technique was applicable in both laparoscopic and open distal pancreatectomy. It is a useful alternative technique to the current traditional methods, especially in the cases of bulky pancreas and very proximal tumours located at the neck of pancreas. In the short video we demonstrate the steps of the laparoscopic DP including mobilisation of the pancreatic body from the retroperitoneum, division of the parenchyma with energy device isolating the pancreatic duct (PD), application of a double ligaclip on the proximal duct, division of the PD and finally suturing of the pancreatic stump. Conclusions: CLASP technique is an effective, reproducible, cheap and safe alternative technique, particularly for bulky pancreas, that could be compared to the traditional methods of pancreatic stump closure.