Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

Abstract

Postoperative pancreatic fistula (POPF) is the most frequent and serious complication after distal pancreatectomy (DP) and often leads to other postoperative complications. Numerous studies have been conducted to clarify the risk factors for POPF after DP, and to also determine effective prophylactic treatments. In this article, we review the current evidence on the risk factors for POPF after DP, and also provide new evidence to support the currently implemented prophylactic measures against POPF after DP. The patient-related and surgery-related risk factors and risk factors specific to staplers are discussed. Several studies have suggested that a thick pancreas is a risk factor for POPF using a stapler and that a higher stapler height or pancreatoenteric anastomosis might be useful for preventing POPF when transecting a thick pancreas. Various methods, such as stapler closure, procedures that may be performed in addition to stapler closure, pancreatoenteric anastomosis, pancreatic transection devices, laparoscopic surgery, pancreatic stenting, stump coverage, and somatostatin analogs, have been tested and in comparison with conventional procedures in case-control studies and randomized, controlled trials. Although some studies have shown the superiority of these methods to the conventional procedures, a consensus on precautionary measures that can be taken against POPF remains to be established. Further investigation is necessary to develop a reliable strategy for preventing POPF and to improve the outcomes of patients after DP.

A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients

“…LDP has been accepted as standard procedure for many pancreatic diseases including pancreatic cancer , and our present study supports these reports. However, difficulty of LDP varies depending on the type of operation, tumor size and location, and patient’s body shape.…”

Robotic-Assisted versus Laparoscopic Distal Pancreatectomy: The Results of a Case-Matched Analysis from a Tertiary Care Center

“…As confirmed by literature, the pancreatic fistula is the most common abdominal complication post-DP and its incidence varies from 0 to 47% [47].…”

Utility of drain fluid amylase measurement on the first postoperative day after distal pancreatectomy

“…22,23 Since it was first described in 1979 it has gained popularity as a simple and effective method of parenchymal transection. 12 The European Distal Pancreatectomy Trial Group compared hand-sewn closure with a stapling device and did not observe any significant difference in the incidence of…”

“…11,12,9 However, morbidity occurs in up to one third of patients undergoing distal pancreatectomy, with POPF the most frequent complication. The reported incidence of POPF is 2-64.9% [10][11][12] within high volume centres and if left untreated can result in leakage of pancreatic enzymes into the peritoneal cavity which is associated with major complications including intra-abdominal collections, post-pancreatectomy haemorrhage 8,13 and delayed gastric emptying. 14,15 In this study we report that a DFA1 of less than 600 excluded POPF with 100% sensitivity.…”