Novel CLASP technique for stump closure following distal pancreatectomy

Abstract

Background: Pancreatic fistula remains the primary source of morbidity following distal pancreatectomy. There is currently no optimal stump closure technique to reduce pancreatic fistula rates. Methods: Video 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 using the CLASP technique. Results: Five patients (3 females) with a median age of 65 underwent distal pancreatectomy and splenectomy for pancreatic body or tail tumour. Four of those operations were done laparoscopically. Only one patient developed a grade A pancreatic fistula. No other postoperative complications were noticed. The median length of stay was 6 days. Clear resection margins achieved in all patients (R0 resection). CLASP technique was applicable in both laparoscopic and open distal pancreatectomy. The key points are the mobilisation of the pancreatic body from the retroperitoneum, the isolation of the pancreatic duct with application of a double ligaclip on the proximal duct and the suturing of the pancreatic stump. Conclusion: CLASP technique is an effective, reproducible, cheap and safe alternative technique, particularly for fat bulky pancreas, that could be compared to the traditional methods of pancreatic stump closure.