Abstract
Pancreatic fistula is the most common major complication to occur after distal pancreatectomy, ranging in frequency from 5% to 40%. The appropriate technique for treating the pancreatic stump still remains controversial. Thirty-six patients underwent distal pancreatectomy in Kagawa University Hospital between January 2000 and February 2007. Their hospital records were reviewed to evaluate the usefulness of a stapling closure using several types of staplers in comparison to a suture closure. They were subdivided according to the method used to close the pancreas stump: the suture group comprised 11 patients, the staple group comprised 24 patients, including 7 patients for whom was used the new endopath stapler Echelon 60 (Ethicon Endo-surgery; Johnson & Johnson, Cincinnati, OH, USA). Overall pancreatic fistula rate was 17% (6/36) in this series. In the staple group, 3 of the 24 patients (12%) developed a pancreatic fistula, whereas in the suture group, 3 of 11 patients (27%) developed a pancreatic fistula. Of the 7 patients for whom the Echelon 60 was used, none developed a pancreatic fistula. The length of postoperative hospital stay was also significantly shorter for the patients with the Echelon 60 than in the patients either with sutures or another stapling device. These findings support the advantages of using a stapler closure in distal pancreatectomy. This method, using a new stapler device, is considered to be a simple and safe alternative to the standard suture closure technique.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’Graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg 2003;138:1310–1314; discussion 1315.
Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002;183:237–241.
Andren-Sandberg A, Wagner M, Tihanyi T, Lofgren P, Friess H. Technical aspects of left-sided pancreatic resection for cancer. Dig Surg 1999;16:305–312.
Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ. Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 1999;229:693–698; discussion 698–700.
Moriura S, Kimura A, Ikeda S, Iwatsuka Y, Ikezawa T, Naiki K. Closure of the distal pancreatic stump with a seromuscular flap. Surg Today 1995;25:992–994.
Suzuki Y, Kuroda Y, Morita A, Fujino Y, Tanioka Y, Kawamura T, et al. Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Arch Surg 1995;130:952–955.
Kajiyama Y, Tsurumaru M, Udagawa H, Tsutsumi K, Kinoshita Y, Akiyama H. Quick and simple distal pancreatectomy using the GIA stapler: report of 35 cases. Br J Surg 1996;83:1711.
Kluger Y, Alfici R, Abbley B, Soffer D, Aladgem D. Gastric serosal patch in distal pancreatectomy for injury: a neglected technique. Injury 1997;28:127–129.
Ohwada S, Ogawa T, Tanahashi Y, Nakamura S, Takeyoshi I, Ohya T, et al. Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg 1998;22:494–498.
Suzuki Y, Fujino Y, Tanioka Y, Hori Y, Ueda T, Takeyama Y, et al. Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg 1999;86:608–611.
Adam U, Makowiec F, Riediger H, Trzeczak S, Benz S, Hopt UT. Distal pancreatic resection: indications, techniques and complications. Zentralbl Chir 2001;126:908–912.
Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW. Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 2003;90:190–196.
Sheehan MK, Beck K, Creech S, Pickleman J, Aranha GV. Distal pancreatectomy: does the method of closure influence fistula formation? Am Surg 2002;68:264–267; discussion 267–8.
Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, et al. Distal pancreatectomy: is staple closure beneficial? A N Z J Surg 2003;73:922–925.
Balzano G, Zerbi A, Cristallo M, Di Carlo V. The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg 2005;9:837–842.
Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005;92:539–546.
Kleeff J, Diener MK, Z’Graggen K, Hinz U, Wagner M, Bachmann J, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 2007;245:573–582.
Yo LS, Consten EC, Quarles van Ufford HM, Gooszen HG, Gagner M. Buttressing of the staple line in gastrointestinal anastomoses: overview of new technology designed to reduce perioperative complications. Dig Surg 2006;23:283–291.
Pachter HL, Pennington R, Chassin J, Spencer FC. Simplified distal pancreatectomy with the Auto Suture stapler: preliminary clinical observations. Surgery (St. Louis) 1979;85:166–170.
Author information
Authors and Affiliations
About this article
Cite this article
Okano, K., Kakinoki, K., Yachida, S. et al. A simple and safe pancreas transection using a stapling device for a distal pancreatectomy. J Hepatobiliary Pancreat Surg 15, 353–358 (2008). https://doi.org/10.1007/s00534-008-1328-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00534-008-1328-8