Efficacy of our standardized procedure with mesh-reinforced stapler to prevent pancreatic fistula after distal pancreatectomy

Abstract

Background: The aim of this study was to evaluate whether our standardized procedure with mesh-reinforced stapler (Endo-GIATM with Tri-StapleTM technology; black reload; 60-m long; Covidien) can reduce the incidence of postoperative pancreatic fistula (POPF) after distal pancreatectomy. Methods: A total of 60 patients underwent mesh-reinforced stapled distal pancreatectomy at our institute from July 2016 to November 2019. Laparoscopic distal pancreatectomy was performed in 43 (71.7%) patients. The incidence of clinically relevant POPF (grade B or C based on the International Study Group on Pancreatic Fistula criteria) was retrospectively analyzed. Surgical procedures: The pancreatic parenchyma was transected by stapler on the transection line with safety margin from the lesion. The closure jaw was carefully clamped over a 1-min period at a fixed speed. The stapler was slowly fired over a 6-min period and then released. Careful, gentle handling of the stapler was required during transection of the pancreatic parenchyma. A closed-suction drain was always placed near the stump of the remnant pancreas. Results: The median operative time was 274min (133-585), and median operative blood loss was 170g (1-2519). The incidence of clinically relevant POPF occurred in 4 patients (6.7%). We have never experienced POPF grade C. The major morbidity rate (Clavien-Dindo classification grade ≥III) occurred in 7 patients (15%). Complications other than POPF grade B occurred in 3 patients (ileus, n=2; delayed gastric emptying, n=1). No surgical mortality or in-hospital death occurred in this study. Conclusions: Our standardized technique with mesh-reinforced stapler can reduce clinically relevant POPF after distal pancreatectomy.