Abstract
BackgroundIn recent years, many advances in pancreatic surgery have been achieved. Nevertheless, the rate of pancreatic fistula following pancreatic tail resection does not differ between various techniques, still reaching up to 30% in prospective multicentric studies. Taking into account contradictory results concerning the usefulness of covering resection margins after distal pancreatectomy, we sought to perform a systematic, retrospective analysis of patients that underwent distal pancreatectomy at our center.MethodsWe retrospectively analysed the data of 74 patients that underwent distal pancreatectomy between 2001 and 2011 at the community hospital in Neuss. Demographic factors, indications, postoperative complications, surgical or interventional revisions, and length of hospital stay were registered to compare the outcome of patients undergoing distal pancreatectomy with coverage of the resection margins vs. patients undergoing distal pancreatectomy without coverage of the resection margins. Differences between groups were calculated using Fisher’s exact and Mann–Whitney U test.ResultsMain indications for pancreatic surgery were insulinoma (n=18, 24%), ductal adenocarcinoma (n=9, 12%), non-single-insulinoma-pancreatogenic-hypoglycemia-syndrome (NSIPHS) (n=8, 11%), and pancreatic cysts with pancreatitis (n=8, 11%). In 39 of 74 (53%) patients no postoperative complications were noted. In detail we found that 23/42 (55%) patients with coverage vs. 16/32 (50%) without coverage of the resection margins had no postoperative complications. The most common complications were pancreatic fistulas in eleven patients (15%), and postoperative bleeding in nine patients (12%). Pancreatic fistulas occurred in patients without coverage of the resection margins in 7/32 (22%) vs. 4/42 (1011%) with coverage are of the resection margins, yet without reaching statistical significance. Postoperative bleeding ensued with equal frequency in both groups (12% with coverage versus 13% without coverage of the resection margins). The reoperation rate was 8%. The hospital stay for patients without coverage was 13 days (5–60) vs. 17 days (8–60) for patients with coverage.ConclusionsThe results show no significant difference in the fistula rate after covering of the resection margin after distal pancreatectomy, which contributes to the picture of an unsolved problem.
Highlights
In recent years, many advances in pancreatic surgery have been achieved
In the last 20 years several studies have focused on distal pancreatectomy, which accounts for up to 10% of all pancreatic resections [5]
Despite the advantages of laparoscopic distal pancreatectomy with reduction of postoperative pain, wound infection rates, and intraoperative blood loss, there are no significant differences in the rate of pancreatic fistulas when compared to open surgery [8,9,10]
Summary
Many advances in pancreatic surgery have been achieved. the rate of pancreatic fistula following pancreatic tail resection does not differ between various techniques, still reaching up to 30% in prospective multicentric studies. Despite the advantages of laparoscopic distal pancreatectomy with reduction of postoperative pain, wound infection rates, and intraoperative blood loss, there are no significant differences in the rate of pancreatic fistulas when compared to open surgery [8,9,10]. In this context, many different surgical techniques for pancreatic resection and closure of the resection margin were described, such as closure by stapler with or without suture, pancreaticoenteric anastomoses with various modifications, mesh-application, or closure with fibrin glue. None of these techniques were superior concerning the rate of pancreatic fistulas [1,5,6,11]
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