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Modified Reinforced Staple Closure Technique Decreases Postoperative Pancreatic Fistula After Distal Pancreatectomy

  • Ryoichi MiyamotoEmail author
  • Naoki Sano
  • Michihiro Maeda
  • Satoshi Inagawa
  • Nobuhiro Ohkohchi
Original Article
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Abstract

Postoperative pancreatic fistula (POPF) is a serious complication that can occur following distal pancreatectomy (DP). Recent studies demonstrated that the use of reinforced staplers with bioabsorbable mesh significantly reduced the incidence of POPF, although the safety and efficacy of this approach remain controversial. Therefore, we originally developed a modified closure technique that combines the use of a reinforced stapler with bioabsorbable mesh with suture closure of the main pancreatic duct. The aim of this study was to determine whether our closure technique is predictive of POPF after DP. Fifty-nine consecutive patients who underwent DP were retrospectively enrolled. Based on the closure technique, we divided the cohort into a suture group (group A; n = 39) and a modified closure group (group B; n = 20). Using multivariate analysis, surgical closure techniques, including our method, and other well-known POPF risk factors were independently assessed. Multivariate logistic regression analysis identified no pathological fibrosis (odds ratio [OR], 5.41; p < 0.01), body mass index (> 25 kg/m2) (OR, 3.01; p = 0.02), and pancreatic stump closure technique (group A) (OR, 2.04; p = 0.01) as independent risk factors for POPF. The present study indicated that our modified closure technique is an additional useful technique to reduce POPF after DP.

Keywords

Distal pancreatectomy DP Pancreatic fistula POPF Staple closure 

Notes

Compliance with Ethical Standards

The ethics committee of the Tsukuba Medical Center Hospital approved this study.

Conflict of Interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Mayo WJ (1913) I. the surgery of the pancreas: I.Injuries to the pancreas in the course of operations on the stomach. II. Injuries to the pancreas in the course of operations on the spleen. III. Resection of half the pancreas for tumor. Ann Surg 58:145–150CrossRefGoogle Scholar
  2. 2.
    Fernandez-Cruz L, Poves I, Pelegrina A, Burdío F, Sánchez-Cabus S, Grande L (2016) Laparoscopic distal pancreatectomy for pancreatic tumors: does size matter? Dig Surg 33:290–298CrossRefGoogle Scholar
  3. 3.
    Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698CrossRefGoogle Scholar
  4. 4.
    Reeh M, Nentwich MF, Bogoevski D, Koenig AM, Gebauer F, Tachezy M, Izbicki JR, Bockhorn M (2011) High surgical morbidity following distal pancreatectomy: still an unsolved problem. World J Surg 35:1110–1117CrossRefGoogle Scholar
  5. 5.
    Kleeff J, Diener MK, Z’Graggen K et al (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582CrossRefGoogle Scholar
  6. 6.
    Nathan H, Cameron JL, Goodwin CR, Seth AK, Edil BH, Wolfgang CL, Pawlik TM, Schulick RD, Choti MA (2009) Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg 250:277–281CrossRefGoogle Scholar
  7. 7.
    Peng YP, Zhu XL, Yin LD, Zhu Y, Wei JS, Wu JL, Miao Y (2017) Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis. Sci Rep 7:185CrossRefGoogle Scholar
  8. 8.
    Hassenpflug M, Hinz U, Strobel O, Volpert J, Knebel P, Diener MK, Doerr-Harim C, Werner J, Hackert T, Büchler MW (2016) Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER randomized controlled trial). Ann Surg 264:723–730CrossRefGoogle Scholar
  9. 9.
    Weniger M, D’Haese JG, Crispin A, Angele MK, Werner J, Hartwig W (2016) Autologous but not fibrin sealant patches for stump coverage reduce clinically relevant pancreatic fistula in distal pancreatectomy: a systematic review and meta-analysis. World J Surg 40:2771–2781CrossRefGoogle Scholar
  10. 10.
    Hüttner FJ, Mihaljevic AL, Hackert T, Ulrich A, Büchler MW, Diener MK (2016) Effectiveness of Tachosil(®) in the prevention of postoperative pancreatic fistula after distal pancreatectomy: a systematic review and meta-analysis. Langenbeck’s Arch Surg 401:151–159CrossRefGoogle Scholar
  11. 11.
    Fisher WE, Chai C, Hodges SE, Wu MF, Hilsenbeck SG, Brunicardi FC (2008) Effect of BioGlue on the incidence of pancreatic fistula following pancreas resection. J Gastrointest Surg 12:882–890CrossRefGoogle Scholar
  12. 12.
    Sudo T, Murakami Y, Uemura K, Hayashidani Y, Hashimoto Y, Nakashima A, Ohge H, Sueda T (2011) Distal pancreatectomy with duct-to-mucosa pancreaticogastrostomy: a novel technique for preventing postoperative pancreatic fistula. Am J Surg 202:77–81CrossRefGoogle Scholar
  13. 13.
    Kawai M, Hirono S, Okada K, Sho M, Nakajima Y, Eguchi H, Nagano H, Ikoma H, Morimura R, Takeda Y, Nakahira S, Suzumura K, Fujimoto J, Yamaue H (2016) Randomized controlled trial of pancreaticojejunostomy versus stapler closure of the pancreatic stump during distal pancreatectomy to reduce pancreatic fistula. Ann Surg 264:180–187CrossRefGoogle Scholar
  14. 14.
    Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, Tomazic A, Bruns CJ, Busch ORC, Farkas S, Belyaev O, Neoptolemos JP, Halloran C, Keck T, Niedergethmann M, Gellert K, Witzigmann H, Kollmar O, Langer P, Steger U, Neudecker J, Berrevoet F, Ganzera S, Heiss MM, Luntz SP, Bruckner T, Kieser M, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377:1514–1522CrossRefGoogle Scholar
  15. 15.
    Yamashita YI, Tsujita E, Chikamoto A, Imai K, Kaida T, Yamao T, Umezaki N, Nakagawa S, Hashimoto D, Baba H (2017) Linear stapling device with pre-attached bioabsorbable polyglycolic acid felt reduces postoperative pancreatic fistula after distal pancreatectomy. Anticancer Res 37:1865–1868CrossRefGoogle Scholar
  16. 16.
    Kawai M, Hirono S, Okada KI, Satoi S, Yanagimoto H, Kon M, Murakami Y, Kondo N, Sho M, Akahori T, Toyama H, Fukumoto T, Fujii T, Matsumoto I, Eguchi H, Ikoma H, Takeda Y, Fujimoto J, Yamaue H (2017) Reinforced staplers for distal pancreatectomy. Langenbeck’s Arch Surg 402:1197–1204CrossRefGoogle Scholar
  17. 17.
    Hamilton NA, Porembka MR, Johnston FM, Gao F, Strasberg SM, Linehan DC, Hawkins WG (2012) Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial. Ann Surg 255:1037–1042CrossRefGoogle Scholar
  18. 18.
    Johnston FM, Cavataio A, Strasberg SM, Hamilton NA, Simon PO Jr, Trinkaus K, Doyle MBM, Mathews BD, Porembka MR, Linehan DC, Hawkins WG (2009) The effect of mesh reinforcement of a stapled transection line on the rate of pancreatic occlusion failure after distal pancreatectomy: review of a single institution’s experience. HPB (Oxford) 11:25–31CrossRefGoogle Scholar
  19. 19.
    Goh BK, Tan YM, Chung YF et al (2008) Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg 143:956–965CrossRefGoogle Scholar
  20. 20.
    Xia T, Zhou JY, Mou YP, Xu XW, Zhang RC, Zhou YC, Chen RG, Lu C, Huang CJ (2017) Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon. PLoS One 12:e0172857CrossRefGoogle Scholar
  21. 21.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) International study group on pancreatic fistula definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefGoogle Scholar
  22. 22.
    Hirashita T, Ohta M, Yada K, Tada K, Saga K, Takayama H, Endo Y, Uchida H, Iwashita Y, Inomata M (2018) Effect of pre-firing compression on the prevention of pancreatic fistula in distal pancreatectomy. Am J Surg 216:506–510CrossRefGoogle Scholar
  23. 23.
    Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, Rodriguez R, Thayer SP, Fernandez-del Castillo C (2008) Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg 12:1691–1697CrossRefGoogle Scholar
  24. 24.
    Finan KR, Cannon EE, Kim EJ, Wesley MM, Arnoletti PJ, Heslin MJ, Christein JD (2009) Laparoscopic and open distal pancreatectomy: a comparison of outcomes. Am Surg 75:671–679Google Scholar
  25. 25.
    Roberson LD, Netherland DE, Dhillon R, Heath BJ (1998) Air leaks after surgical stapling in lung resection: a comparison between stapling alone and stapling with staple-line reinforcement materials in a canine model. J Thorac Cardiovasc Surg 116:353–354CrossRefGoogle Scholar
  26. 26.
    Consten EC, Gagner M, Pomp A, Inabnet WB (2004) Decreased bleeding after laparoscopic sleeve gastrectomy with or without duodenal switch for morbid obesity using a stapled buttressed absorbable polymer membrane. Obes Surg 14:1360–1366CrossRefGoogle Scholar
  27. 27.
    Kurahara H, Maemura K, Mataki Y et al (2014) Closure of the pancreas in distal pancreatectomy: comparison between bare stapler and reinforced stapler. Hepatogastroenterol 61:2367–2370Google Scholar
  28. 28.
    Jang JY, ShinYC HY et al (2007) Effect of polyglycolic acidmesh for prevention of pancreatic fistula following distal pancreatectomy: a randomized clinical trial. JAMA Surg 152:150–155CrossRefGoogle Scholar
  29. 29.
    Jensen EH, Portschy PR, Chowaniec J, Teng M (2013) Meta-analysis of bioabsorbable staple line reinforcement and risk of fistula following pancreatic resection. J Gastrointest Surg 17:267–272CrossRefGoogle Scholar
  30. 30.
    Chikamoto A, Hashimoto D, Ikuta Y, Tsuji A, Abe S, Hayashi H, Imai K, Nitta H, Ishiko T, Watanabe M, Beppu T, Baba H (2014) Effects of the closing speed of stapler jaws on bovine pancreases. Surg Endosc 28:336–340CrossRefGoogle Scholar
  31. 31.
    Kawai M, Tani M, Okada K, Hirono S, Miyazawa M, Shimizu A, Kitahata Y, Yamaue H (2013) Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy. Am J Surg 206:352–359CrossRefGoogle Scholar
  32. 32.
    Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Oncology 2019

Authors and Affiliations

  1. 1.Department of Gastroenterological SurgeryTsukuba Medical Center HospitalTsukubaJapan
  2. 2.Department of Surgery, Division of Gastroenterological and Hepatobiliary Surgery and Organ TransplantationUniversity of TsukubaTsukubaJapan

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