Preventing clinically relevant pancreatic fistula with combination of linear stapling plus continuous suture of the stump in laparoscopic distal pancreatectomy
Takeshi Aoki,
Doaa A. Mansour,
Tomotake Koizumi,
Kazuhiro Matsuda,
Tomokazu Kusano,
Yusuke Wada,
Tomoki Hakozaki,
Kodai Tomioka,
Takahito Hirai,
Tatsuya Yamazaki,
Makoto Watanabe,
Koji Otsuka,
Ahmed Elewa Abbas Gahin,
Masahiko Murakami
Affiliations
Takeshi Aoki
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Doaa A. Mansour
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Tomotake Koizumi
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Kazuhiro Matsuda
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Tomokazu Kusano
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Yusuke Wada
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Tomoki Hakozaki
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Kodai Tomioka
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Takahito Hirai
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Tatsuya Yamazaki
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Makoto Watanabe
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Koji Otsuka
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Ahmed Elewa Abbas Gahin
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Masahiko Murakami
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University
Abstract Background 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. Methods Twenty-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. Results POPF 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. Conclusions The triple combination of linear stapling, peri-firing compression plus continuous suture in LDP has effectively prevented occurrence of clinically relevant ISGPF POPF. Trial registration The study was retrospectively registered September 30, 2019 at Showa University Ethics Committee as IRB protocol numbers 2943.
