Pancreatic Stump Reinforcement with Falciform Ligament during Laparoscopic Distal Pancreatectomy

Abstract

Purpose: Pancreatic fistula (PF) is the most common and dangerous complication after distal pancreatectomy (DP). The most effective technique of pancreatic stump closure still unclear. Here, we aimed to compare the efficiency of implementation of falciformed ligament (FL) pancreatic stump closure techniques for preventing PF during laparoscopic DP. Methods: All patients between November 2014 and February 2021 who had laparoscopic DP with pancreatic stump covered with FL or no FL covered was retrieved. Their intra- and postoperative outcomes (Operative time, blood loss, length of hospital stay, postoperative complication according to Clavien-Dindo) were compared. Results: A total of 118 patients were included. Group A - 23 patients with pancreatic stump peirnforcement with FL and group B 95 patients without pancreatic stump reinforcement with FL. Median operative time was 260 (165-510) and 247,5 (range 155-535)min, in group A and B, respectively. and median blood loss was 100 (range 5 - 1000) and 100(range 20-300)ml, in group A and B, respectively. Postoperative stay 8(5-40) days and 9,5(6-38) days (P = 0.590) in group A and B, respectively. Postoperative pancreatic fistula (PPF) grade B occurred in 30% (n7) vs 27%(n26), (P > 0.005) and grade C occurred in 0% vs 3%(n3) P = 0.005, in group A and B, respectively. Conclusion: Pancreatic stump reinforcement with falciformed ligament during laparoscopic distal pancreatectomy is safe and feasible procedure. Prospective multi-centric trials are needed for further evaluation of the technique.