Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use

Abstract

The most important risk factor for POPF after DP was suggested to be the thickness of the pancreatic stump, reflecting the volume of remnant pancreas. A triple-row stapler seemed to be superior to a double-row stapler in preventing POPF. However, triple-row stapler use in a thick pancreas is considered to be a future problem to be solved.

Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue

“…Table 3 shows the impact on POPF of the clinical factors that we tested; no factor was significantly associated with the occurrence of POPF. In previous reports, thick pancreatic parenchyma was significantly associated with an increased incidence of POPF [11,[22][23][24]; however, in our study, the average thickness of the pancreatic parenchyma in PFnegative patients was 10.4±2.6 mm, which was not significantly different from that of the PF-positive patients (10.1± 2.2 mm) (P=0.639). Next, we assessed the impact of thickness of the pancreatic parenchyma on the incidence of PF and drain amylase levels.…”

“…However, compressing the pancreas itself could cause injury to the pancreatic parenchyma during both techniques, potentially leading to clinically relevant PF, especially in cases with a thick pancreatic parenchyma. Indeed, a thick pancreatic parenchyma is reported to be a risk factor for increased incidence of POPF [11,[22][23][24]. In this context, closure of the pancreatic stump, with minimization of injury to the pancreatic parenchyma, is critical to decreasing the risk of PF after DP.…”

Attempts to prevent postoperative pancreatic fistula after distal pancreatectomy

“…Several authors investigated the risk factors for POPF after DP with stapler closure [9,11,[22][23][24][25][26][27]. Most of them reported that a thick pancreas was a risk factor for POPF [9,11,22,24,25,27].…”

Preventing Pancreatic Fistula Following Distal Pancreatectomy

“…Recently, a multivariate analysis identified increased thickness of the pancreatic body as a risk factor for failure with stapled transections. Additionally, use of a double-row (as opposed to a triple-row) stapler load was associated with increased risk of fistula [20].…”