Abstract
BackgroundPancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity. The aim of our study is to compare linear stapling closure plus continuous suture with linear stapling closure alone during laparoscopic distal pancreatectomy (LDP) in terms of clinically relevant postoperative pancreatic fistula (POPF) rate.MethodsTwenty-two patients underwent LDP at our institution between 2011 and 2013. Twelve patients had linear stapling closure with peri-firing compression (LSC) alone compared with ten patients who had linear stapling closure, peri-firing compression plus continuous suture (LSC/CS) for stump closure of remnant pancreas in LDP. Biochemical leak and clinically relevant POPF were compared between both groups.ResultsPOPF occurred in 4 of 12 (33.3%) patients with linear stapling closure while no patient developed a clinically relevant POPF in the triple combination of linear stapling, peri-firing compression plus continuous suture group (p = 0.043).1 patient (8.3%) in the LSC group and 5 patients (50%) in the LSC/CS group had evidence of a biochemical leak. There were no significant differences in operative time (188.3 vs 187.0 min) and blood loss (135 vs. 240 g) between both groups but there was a significantly of shorter length of hospital stay (11.9 vs. 19.9 days) in LSC/CS group (p = 0.037). There was no mortality in either group.ConclusionsThe triple combination of linear stapling, peri-firing compression plus continuous suture in LDP has effectively prevented occurrence of clinically relevant ISGPF POPF.Trial registrationThe study was retrospectively registered September 30, 2019 at Showa University Ethics Committee as IRB protocol numbers 2943.
Highlights
Pancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity
Mortality associated with laparoscopic distal pancreatectomy (LDP) has steadily decreased to reach less than 2% [4,5,6,7], yet, its morbidity continues to be significant mostly due to postoperative pancreatic fistula (POPF) [6,7,8] originating from the exposed and transected pancreatic parenchyma [8]
We report on our experience with LDP implementing a triple combination of stapler closure after prolonged compression before and after firing buttressed by suture closure and compare it to conventional stapler closure with peri-firing compression
Summary
Pancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity. The aim of our study is to compare linear stapling closure plus continuous suture with linear stapling closure alone during laparoscopic distal pancreatectomy (LDP) in terms of clinically relevant postoperative pancreatic fistula (POPF) rate. Mortality associated with laparoscopic distal pancreatectomy (LDP) has steadily decreased to reach less than 2% [4,5,6,7], yet, its morbidity continues to be significant mostly due to postoperative pancreatic fistula (POPF) [6,7,8] originating from the exposed and transected pancreatic parenchyma [8]. In 2011, the DISPACT trial, a large muticenter RCT brought evidence that mechanical stapling is not superior to suture closure of the pancreatic remnant in terms of pancreatic fistula and mortality [13]. Despite the abundance of reports on various closure techniques, the rate of pancreatic fistula remains high and the controversy prevails [7]
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