Greater Omentum Binding: A Simple Technique to Cover the Pancreatic Remnant after Distal Pancreatectomy

Wang, Min; Zhu, Feng; Peng, Feng; Tian, Rui; Shi, Changcheng; Xu, Meng; Li, Xu; Wang, Xin; Shen, Ming; Qin, Renyi

doi:10.1016/j.jamcollsurg.2014.01.066

Cited by 7 publications

(2 citation statements)

References 21 publications

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“…The mortality associated with this procedure is reported as less than 5% in high-volume centers [3–9], and the morbidity rate remains high ranging from 22% to 50% [10–12]. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60% [13, 14]. Pancreatic fistula is defined as a drain output of any measurable volume of fluid with an amylase level >3 times the upper limit of institutional normal serum amylase activity, associated with a clinically relevant development/condition related directly to the postoperative pancreatic fistula [15], and the grades are defined in Table 1.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Pancreatic Fistula in Distal Pancreatectomy Patients

Jiwani

Chawla

2019

Surgery Research and Practice

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Introduction. Benign and malignant lesions of the pancreas located at the body and tail of the pancreas are managed by the standard procedure of distal pancreatectomy (DP). The mortality associated with this procedure is reported as less than 5% in high-volume centers. The major proportion of morbidity is comprised of pancreatic fistula with a reported incidence of 5% to 60%. The most considered risk factors associated with pancreatic fistula formation are soft pancreatic texture, diameter of the pancreatic duct <3 mm, intraoperative blood loss >1000 ml and surgical techniques. Among all these factors, the modifiable factor is the surgical technique. Several surgical techniques have been developed and modified for closure of the pancreatic remnant in the recent past in order to minimize the risk of pancreatic fistula and other complications. The main objective of the study is to analyze the factors associated with formation of pancreatic fistula after distal pancreatectomy. Patients and Methods. We performed a single-center retrospective study at Aga Khan University Hospital from January 2004 till December 2015. The perioperative and postoperative data of 131 patients who underwent pancreatic resection were recorded by using ICD 9 coding. 45 patients underwent distal pancreatectomy, out of which 38 were included in the study based on inclusion criteria. Variables were grouped into demographics, indications, operative details, and postoperative course. Statistical analysis software (SPSS) was used for analysis. Quantitative variables were presented as mean with standard deviation or median with interquartile range depending on the distribution of data. Study endpoints for the risk factor analysis were surgical morbidity and development of pancreatic fistula. Univariate logistic regressions were performed associated with study endpoints. P value less than 0.05 was considered significant. Results. Postoperative pancreatic fistula was the most common perioperative morbidity. The significant associated risk factor for pancreatic fistula was multivisceral resection as compared to spleen-preserving distal pancreatectomy (P value 0.039). However, the technique of stump closure when opted for suture techniques was seen to be associated with a higher occurrence of postoperative pancreatic fistula. The mortality rate was 2.6%. Conclusion. Postoperative pancreatic fistula is the most common complication seen after distal pancreatectomy in our series. Multivisceral resection is associated with a high incidence of pancreatic fistula and is a statistical significant predictor of pancreatic fistula.

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Section: Introductionmentioning

confidence: 99%

Risk Factors of Pancreatic Fistula in Distal Pancreatectomy Patients

Jiwani

Chawla

2019

Surgery Research and Practice

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“…The results showed that this method could reduce the incidence of POPF, and multivariate analysis proved that this EJ embedding approach was an independent protective factor for POPF. In addition, Wang et al [31] proposed to cover the pancreatic stump with the greater omentum during DP, which can reduce the incidence of pancreatic fistula and is less expensive, practical, and safe.…”

Section: Application Of Pancreatic Stump-covering Materialsmentioning

confidence: 99%

Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions

2019

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Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection. How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved. Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis. According to the literature, identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication. Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice. After the occurrence of POPF, the treatment of choice should be determined according to the classification of the pancreatic fistula. However, despite the progress and promising treatment approaches, POPF remains to be a clinical issue that warrants further studies in the future.

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