Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation

Bilimoria, Malcolm M.; Cormier, Janice N.; Mun, Yeung Chul; Lee, J E; Evans, Douglas B.; Pisters, Peter W.T.

doi:10.1002/bjs.4032

Cited by 216 publications

(173 citation statements)

References 56 publications

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“…In recent years, the mortality rate after DP has been reduced to less than five percent in high volume centers [1][2][3][4][5] , however morbidity rates remain high ranging from 10-47% 3,[6][7][8] . Pancreatic fistula is the most frequently reported complication and the primary cause of post-operative morbidity following DP [6][7][8][9][10] . Development of pancreatic fistula often leads to further complications such as intra-abdominal abscess, sepsis, hemorrhage, delayed gastric emptying, and occasionally malabsorption.…”

Section: Introductionmentioning

confidence: 99%

“…A wide variety of surgical techniques for parenchymal transection and closure of the pancreatic remnant have been described in an effort to reduce the occurrence of fistula. These techniques include stapled closures, sutured closures, combined stapled and sutured closures, ultrasonic dissection, sealing with fibrin glue, application of mesh, seromuscular flaps, pancreaticoenteric anastomosis and ligation of the main pancreatic duct at the transection line 3,[6][7][8][9][11][12][13][14][15][16][17][18][19][20][21] . Currently, there is no consensus as to the optimal surgical technique 5 for pancreatic transection and stump closure during distal pancreatectomy.…”

Section: Introductionmentioning

confidence: 99%

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Optimal Technical Management of Stump Closure Following Distal Pancreatectomy: A Retrospective Review of 215 Cases

Harris

Abdollahi

Newhook

et al. 2010

Journal of Gastrointestinal Surgery

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal Technical Management of Stump Closure Following Distal Pancreatectomy: A Retrospective Review of 215 Cases

Harris

Abdollahi

Newhook

et al. 2010

Journal of Gastrointestinal Surgery

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“…[40] A multicenter RCT performed in 21 European hospitals found that hand-sewn sutures and closure with stapler were equally effective after distal pancreatectomy, but the identification and suture of a transected pancreatic duct is the only technique able to reduce the incidence of POPF. [41,42] Our standardized technique and the use of a stapled closure of the pancreatic remnant, despite the low number of patients, has proven to be safe, without significant morbidity or mortality, and with similar re-admission rates between groups.…”

Section: Discussionmentioning

confidence: 99%

Mini-invasive distal pancreatectomy: a feasible and cost-effective technique

Basso¹,

Maffeis²,

Lumachi³

et al. 2017

MIS

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Aim: Laparoscopic pancreatic surgery is a minimally invasive technique that has been widely applied only in the past decade. The purpose of this study was to evaluate its safety and assess whether laparoscopic distal pancreatectomy (LDP) is cost-effective compared with open distal pancreatectomy (ODP). Methods: The medical records of patients treated for leftsided pancreatic lesions were retrospectively analysed, and the analysis of costs for hospital stay, operative time, and equipment were analysed. Twelve patients underwent LDP, while 12 patients underwent ODP. Results: The two groups were homogeneous according to age, ASA score, BMI, and distribution of pathological findings. Both the size of the specimen (5.33 ± 3.2 vs. 5.58 ± 2.57 cm) and the number of removed lymph nodes (10.5 ± 4.3 vs. 12.1 ± 3.1) did not differ. Although LDP required a longer operative time (197.5 ± 33.7 vs. 122.5 ± 35.4 min), intraoperative bleeding, postoperative pain intensity (measured by VAS scale) and hospital stay were significantly reduced. Conclusion: The mini-invasive approach offers several advantages compared with open surgery, including a significant reduction of blood loss and postoperative pain, and an earlier recovery. The global costs of laparoscopic surgery should be carefully re-evaluated, considering the saving that arises from these advantages. Key words:Mini-invasive, distal pancreatectomy, laparoscopy, cost ABSTRACTArticle history:

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“…Identification and ligation of the main pancreatic duct stump, followed by sutured pancreatic stump closure, was the preferred approach, although many techniques were used to close the pancreatic stump, including sutures, staples, mesh application, or a combination of these techniques, again depending on the preference of the surgeon13, 14, 15, 16. A peripancreatic drain was placed routinely in every patient who had a distal pancreatectomy.…”

Section: Methodsmentioning

confidence: 99%

Spleen-preservingversusspleen-sacrificing distal pancreatectomy in adults with blunt major pancreatic injury

2018

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BackgroundThe aim of this study was to analyse outcomes of spleen‐preserving (SPDP) and spleen‐sacrificing (SSDP) distal pancreatectomy in adults with severe blunt pancreatic injuries.MethodsThis was an observational study of adult patients who underwent distal pancreatectomy for grade III or IV blunt pancreatic injury between 1991 and 2015. Outcomes of SPDP and SSDP were compared.ResultsFifty‐one patients were included, of whom 23 underwent SPDP and 28 SSDP. The median Injury Severity Score (ISS) was 13·0 (i.q.r. 9·0–18·0). No significant differences were observed between the groups regarding sex, trauma mechanism, shock at triage, laboratory data, location, ISS, associated injury, length of stay, mortality or morbidity. Age (27·0 versus 36·5 years; P = 0·012) and time interval from injury to distal pancreatectomy (15·0 versus 44·0 h; P = 0·022) differed significantly between SPDP and SSDP groups respectively. The mortality rate was 4 per cent (1 of 23) versus 11 per cent (3 of 28) respectively (P = 0·617). Nine patients (39 per cent) developed abdominal morbidity after SPDP, compared with 17 (61 per cent) after SSPD (P = 0·125). In the SPDP group, eight patients had grade B postoperative pancreatic fistula (POPF), two of whom required further intervention. In the SSDP group, six of ten patients with grade B POPF required CT‐guided drainage, and a further five patients required reoperation for other causes. There were more reinterventions after SSDP: 11 of 28 (39 per cent) versus 3 of 23 (13 per cent) in the SPDP group (P = 0·037).ConclusionSPDP was performed more often in younger patients and at a shorter interval after severe blunt pancreatic injury. SPDP was associated with fewer reinterventions.

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Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation

Abstract: Pancreatic leak remains a common complication after left pancreatectomy. The incidence of leak is reduced significantly when the pancreatic duct is identified and directly ligated during left pancreatectomy.

Cited by 216 publications

References 56 publications

Optimal Technical Management of Stump Closure Following Distal Pancreatectomy: A Retrospective Review of 215 Cases

Optimal Technical Management of Stump Closure Following Distal Pancreatectomy: A Retrospective Review of 215 Cases

Mini-invasive distal pancreatectomy: a feasible and cost-effective technique

Spleen-preservingversusspleen-sacrificing distal pancreatectomy in adults with blunt major pancreatic injury

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