Laparoscopic distal pancreatectomy: the risk of pancreatic fistula is mainly related to the drainage modality

Abstract

Introduction: Pancreatic fistula (PF) remains a major concern after distal pancreatectomy (DP). Our aim was to study the risk factors of PF after laparoscopic distal pancreatectomy (LDP). Methods: Between January 2008 and July 2014, 129 LDP were performed, the pancreas was closed by mechanical stapler. Drainage was done by multi-tubular drain (first 40 cases) and small closed suction drain (last 89 cases). PF was defined according to ISGPF. Patients who had PF grade B+C (group 1; n = 37, 29%) were compared to those without or with PF grade A (group 2; n = 92, 71%). Results: No difference between groups 1 and 2 regarding the age (56 vs 54 year), the male gender (35% vs 42%), diabetes (19% vs 22%), median BMI (26 vs 25 kg/m2), malignancy rate (43% vs 47%), section on the neck (46% vs 45%), spleen preservation (67% vs 63%), blood loss (280 vs 220 ml), and the mean operative time (190 min vs 180 min). In group 1, the length of the resected pancreas was moderately longer (10.5 cm vs 9.3 cm, p = 0.11). The rate of PF was more elevated in the early of our experience (n = 40) (52% vs 18%, p < 0.001) and with multi-tubular drain compared to small closed section drain (41% vs 4.4%, p < 0.001). On multivariate analysis, the occurrence of PF grade B+C was only related to the mode of drainage (p = 0.004). Conclusions: In LDP, the risk of PF is significantly decreased with the use of small closed suction drain.