Does Pancreatic Stump Closure Method Influence Distal Pancreatectomy Outcomes?

Abstract

Postoperative outcomes after distal pancreatectomy are unaffected by the use of SLRF sealing of the pancreatic stump when compared to traditional suture or reinforced stapling techniques.

Radiofrequency-induced heating versus mechanical stapler for pancreatic stump closure:in vivocomparative study

“…However, we decided to employ simply staplers because our objective was to compare RF-induced heating versus a simple mechanical suture without the possible inflammatory reaction due to a bioabsorbable material. A recent study comparing traditional suture, reinforced stapling, and (saline-linked) RF-heating reported a similar incidence of POPF (range 25-26%) in DP [28]. Future studies should be aimed to compare the reinforced stapling versus RF-heating in experimental models prone to pancreatic fistula formation as employed here.…”

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

“…Others reported a significantly increased incidence of POPF in reinforcement groups [26,48]. Studies in Massachusetts General Hospital, Washington University, and Indiana University showed no difference between mesh reinforcement and stapler only [8,32,49]. Further verification according to multicenter RCTs will be required to clarify the utility of mesh reinforcement when it is performed in addition to stapler closure.…”

“…In addition, the spread of laparoscopic pancreatectomy has facilitated the use of staplers. A variety of studies have been conducted to clarify whether staplers are superior to suture closure [9,15,21,24,[31][32][33][34] (Table 1).…”

A Multidisciplinary Approach to Pancreas Cancer in 2016: A Review

“…Despite decreases in mortality, postpancreatectomy morbidity remains relatively high, on the order of 30–40% (96,97) even at many high-volume centers, including our own (90,95,98). Common complications after pancreatic resection include bleeding, delayed gastric emptying (99), and fistula from any of the three enteric anastomoses: gastrojejunostomy, hepaticojejunostomy, and pancreaticojejunostomy (99–102). The international study group for pancreatic surgery has published consensus definitions for many of these complications, facilitating standardized communication among reporting centers (103–105).…”

“…Among all postpancreatectomy complications, pancreatic fistula remains the most common, and the Achilles’ heel of the operation. Pancreatic fistula occurs in ∼ 15% of patients after pancreatic head resection (pancreatoduodenectomy) and in ∼ 25% of patients after left-sided pancreatic resection (distal pancreatectomy) (102,106). The greatest risk factor for pancreatic fistula development is a normal pancreas, with soft parenchyma and a small pancreatic duct (107).…”