Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy

Kawai, Manabu; Tani, Masaji; Okada, Ken-ichi; Hirono, Seiko; Miyazawa, Motoki; Shimizu, Astusi; Kitahata, Yuji; Yamaue, Hiroki

doi:10.1016/j.amjsurg.2012.11.023

Cited by 94 publications

(80 citation statements)

References 35 publications

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“…Various studies found different independent predictors for fistula formation, but a common aspect is that extensive surgery and the number of comorbidities correlate with PF risk. Uni- and multivariate analyses of registered patient characteristics led to the conclusion that the following factors increase POPF rate [5,6,7,11,12,13,17,18,19,20]. …”

Section: Risk Factors For Fistula Formationmentioning

confidence: 99%

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A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

et al. 2016

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The prevalence of pancreatic diseases needing surgical intervention is continuously rising. Distal pancreatectomy is performed in the case of pathologies affecting the left side of the pancreas. More and more sophisticated surgical techniques have appeared and an increasing number of published articles discuss the possibilities for closure of the pancreatic remnant. However, the optimum solution is still under debate, as none of the examined techniques have been proven superior in reducing the incidence of the most common surgical complication, the formation of a postoperative pancreatic fistula (PF). Fistula rates have been stationary at 20-30% in the past decades despite the apparent advancement of medicine. This review presents a survey of the relevant articles examining different closure strategies and risk factors to reduce fistula formation rate. International medical publication database search and assessment was carried out to include the findings of studies investigating the efficacy of pancreatic remnant closure techniques to gain a clearer view on the complexity of pancreas fistulas. Emphasis is on indications for surgery, risk factors for postoperative fistula formation and strategies to seal the pancreatic remnant to avoid leakage. Findings suggest that careful patient selection, meticulous surgical techniques are equally important to reduce fistula rates. Ideal closure of the pancreatic remnant is still to be developed, as none of the widespread techniques (hand-sewn suture or staple closure) proved to be statistically significantly superior. Additional closure and covering methods (seromuscular patch, falciform ligament patch, pancreatico-enteric anastomosis, reinforced staplers, fibrin glue etc.) can have profitable effect but strong evidences are yet to come due to small case numbers. The recent introduction of standardized classification of PFs and future prospective randomized trials are more likely to be susceptible to determine if any of the standard or experimental closure techniques is more beneficial than the others.

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Section: Risk Factors For Fistula Formationmentioning

confidence: 99%

“…Down-sides are the higher costs and the lack of individual ligation of the MPD. Furthermore, it seems unsafe to use staplers in a pancreas with thick parenchyma [18,28]. …”

Section: Closure Of the Pancreatic Remnantmentioning

confidence: 99%

A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

et al. 2016

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“…Although several techniques have been advocated to close the stump of the remnant pancreas, such as hand-sewn closure, stapler closure, ultrasonic dissection, seromuscular patches, and pancreaticoenteric anastomosis, it remains unclear which of these techniques is optimal [6][7][8][9][10]. Currently, stapler and hand-sewn closures are widely performed as standard techniques [11,12]. Although several studies have reported that stapler closure contributes to a reduction in PF after DP [13][14][15][16], a randomized clinical trial to test the efficacy of stapler closure in DP in comparison with hand-sewn closure (DISPACT trial) revealed that stapler closure did not significantly reduce the incidence of PF [17].…”

Section: Introductionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Akita

Takahashi

Gotoh

et al. 2015

Langenbecks Arch Surg

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“…[5,21] In other studies, the authors have described the superiority of gold or green cartridges in DP. [22][23][24] However, these studies could not clarify the relationship between type of cartridges and POPF. Therefore, the purpose of this study was to find the optimal stapler cartridge according to the thickness in DP.…”

Section: Discussionmentioning

confidence: 96%

Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy

et al. 2016

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Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy

Cited by 94 publications

References 35 publications

A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

A Review of Techniques for Closure of the Pancreatic Remnant following Distal Pancreatectomy

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

Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy

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