Hanging Maneuver for Stomach Traction in Laparoscopic Distal Pancreatic Resections: An Original Technique Applied in 218 Patients

Abstract

Background: Stomach traction done to expose the pancreas is still a problem in laparoscopic left pancreatic resections. We developed a simple hanging maneuver to retract the stomach rapidly and effectively. Methods: After dividing the gastrocolic ligament, the stomach was encircled with a tape, turned along its horizontal axis and pulled with an epigastric trocar, which was later removed. This technique was used in all patients who underwent laparoscopic left pancreatic resections including 165 distal pancreatectomies (DP), 35 central pancreatectomies (CP) and 18 enucleations (En). Demographics, surgical and postoperative outcome data were recorded. Results: There were no mortalities. The mean operative time for DP, CP and En were 174, 191 and 104 min, respectively. The transfusion (0-4%) and conversion (0-3%) rates were low for all procedures. Morbidity was mainly represented by pancreatic fistula and grades (B + C) for DP, CP and En were observed in 26, 22 and 17%, respectively. No complication related to hanging of the stomach, like gastric perforation, was observed. Re-intervention and the mean hospital stay for DP, CP and En were observed in 5, 11 and 0% and were 16, 22 and 12, respectively. The readmission rate was low (0-9%). Conclusions: Hanging maneuver of the stomach is a simple procedure to rapidly, safely and effectively retract the stomach during left laparoscopic pancreatic resections.

Overall Postoperative Morbidity and Pancreatic Fistula Are Relatively Higher after Central Pancreatectomy than Distal Pancreatic Resection: A Systematic Review and Meta-Analysis

“…Overall (I-squared = 89.9%, P = 0.000) Shibata et al [15] Dumitrascu et al [34] Du et al [19] Lee et al [25] Mise et al [14] DiNorcia et al [7] Zhan et al [21] Hirono et al [18] Yamaguchi et al [17] Kang et al [24] Zureikat et al [23] Müller et al [28] Ocuin et al [22] Song et al [26] Cataldegirman et al [27] Shikano et al [16] Balzano et al [29] Dokmak et al [35] Su et al [31] Crippa et al […”

“…Twenty-four studies performed from 1998 to 2018 were included in metaanalysis following a comprehensive literature search Du et al [19] Lee et al [25] Mise et al [14] DiNorcia et al [7] Zhan et al [21] Hirono et al [18] Yamaguchi et al [17] Kang et al [24] Müller et al [28] Ocuin et al [22] Song et al [26] Shikano et al [16] Balzano et al [29] Dokmak et al [35] Su et al [31] Crippa et al [36] BioMed Research International (Table 1). Central pancreatectomy and distal pancreatectomy were performed in 593 and 1226 patients, respectively.…”

“…Central pancreatectomy and distal pancreatectomy were performed in 593 and 1226 patients, respectively. Of these 24 studies, five studies were performed in Japan [14][15][16][17][18], three each in China [19][20][21], USA [7,22,23], and Korea [24][25][26], two each in Germany [27,28] and Italy [29,30], one each in Taiwan [31], Spain [32], Netherlands [33], Romania [34], and France [35], and one combined study in USA and Italy [36]. Among them, two studies were prospective [28,32] and others were retrospective.…”

“…Among them, two studies were prospective [28,32] and others were retrospective. Five studies were performed on minimally invasive procedures (three robotic [21,23,30] and two laparoscopic [26,35]). Indications for the central or distal pancreatectomy were benign pathologies like trauma and pancreatitis, benign and borderline tumors of pancreatic neck and proximal body, and few malignant cases ( Table 2).…”

“…Expected benefits and potential complications create controversies in selecting surgical procedures for lesions of the pancreatic neck and proximal body, so this study was aimed to review all the relevant electronic databases to evaluate and compare intraoperative, short-and long-term, and postoperative outcomes following CP and DP. [17] 10/47 0/0 Balzano et al [29] 32/21 0/0 Su et al [31] 5/11 0/0 Shibata et al [15] Müller et al [28] 36/36 4/4 Crippa et al [36] 93/17 7/28 Ocuin et al [22] 13/18 0/0 Hirono et al [18] 20/24 4/4 Cataldegirman et al [27] 32/34 3/1 DiNorcia et al [7] 50/46 0/4 Lee et al [25] 14/121 0/22 Shikano et al [16] 24/33 2/2 Kang et al [24] 17/22 0/0 Dumitrascu et al [34] 19/21 3/4 Xiang et al [20] 44/55 0/0 Du et al [19] 36/26 0/0 Zhan et al [21] 10/12 0/4 Zureikat et al [23] 13/6 0/77 Song et al [26] 26/96 0/0 Mise et al [14] 8/8 0/0 Herrera-Cabezón et al [32] 10/82 0/23 Jilesen et al [33] 8/51 0/21 Dokmak et al [35] 25/102 10/63 Boggi et al [30] CP: central pancreatectomy; DP: distal pancreatectomy. BioMed Research International 3…”