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Yamasaki Y, Kurahara H, Oi H, Hozaka Y, Idichi T, Kawasaki Y, Mataki Y, Ohtsuka T. Metal-free laparoscopic distal pancreatectomy using transpancreatic mattress suture with polyglycolic acid sheet and fibrin glue: A case report. Asian J Endosc Surg 2023; 16:770-773. [PMID: 37483158 DOI: 10.1111/ases.13229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/27/2023] [Indexed: 07/25/2023]
Abstract
Laparoscopic distal pancreatectomy (LDP) is the standard surgery for malignant and premalignant tumors of the pancreatic body and tail. A stapler is commonly used to close the pancreatic stump due to its simplicity; however, the use of a stapler is associated with the risk of metal allergy and postoperative pancreatic fistula, especially in thick pancreases. Here, we present a case of LDP without metal instruments, including staplers and clips, in a 54-year-old woman with a metal allergy and a thick pancreas. The pancreatic stump was closed using the transpancreatic mattress suture method with a polyglycolic acid sheet (PGA) and fibrin glue. The postoperative course was uneventful. Metal-free LDP is useful and can be adopted regardless of the patient's background, such as a metal allergy or pancreatic thickness.
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Affiliation(s)
- Yoichi Yamasaki
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Hideyuki Oi
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yuto Hozaka
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Tetsuya Idichi
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yota Kawasaki
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Yuko Mataki
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, and Breast and Thyroid Surgery, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan
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Ishizawa T, Akamatsu N, Kaneko J, Arita J, Hasegawa K. Closure and anastomosis of the pancreas using a four-needle three-loop suture device. Glob Health Med 2022; 4:225-229. [PMID: 36119788 PMCID: PMC9420325 DOI: 10.35772/ghm.2022.01044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
Pancreatic juice can leak not only from the main pancreatic duct but also from unclosed ductal branches appearing on the pancreatic stump. We have developed a suture device consisting of three loops of suture attached to four small-curvature needles with the aim to maximize the area of pancreatic parenchyma to be ligated and reduce the number of punctures made on the pancreas during pancreatic closure or anastomosis. In pancreatojejunostomy, the dorsal wall of the jejunum and then the pancreatic parenchyma are sutured using the four needles. Following duct-to-mucosa anastomosis, the ventral jejunal wall is sutured, and the three threads are finally tied sequentially to complete the reconstruction following the Blumgart method. In distal pancreatectomy, the pancreatic stump is sutured from the dorsal aspect sequentially using the four needles, before or after the pancreatic transection. The three threads are then respectively tied on the ventral surface of the pancreas. This device was used in six pancreatoduodenectomies (including two minimally invasive procedures) and five distal pancreatectomies. A postoperative pancreatic fistula requiring additional drainage or repositioning of abdominal drains developed in two patients. No adverse events associated with this device were encountered. The four-needle three-loop suture device can be an alternative to conventional staplers or sutures for closure and anastomosis of the pancreatic stump.
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Affiliation(s)
- Takeaki Ishizawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Hepatobiliary-Pancreatic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Imamura H, Takahashi H, Akita H, Wada H, Mukai Y, Asukai K, Hasegawa S, Fujii Y, Sugase T, Yamamoto M, Takeoka T, Shinno N, Hara H, Kanemura T, Haraguchi N, Nishimura J, Matsuda C, Yasui M, Omori T, Miyata H, Ohue M, Sakon M. The clinical impact of modified transpancreatic mattress sutures with polyglactin 910 woven mesh on postoperative pancreatic fistula in distal pancreatectomy. Surgery 2022; 172:1220-1227. [PMID: 35773024 DOI: 10.1016/j.surg.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND We previously reported the stump closure method for the remnant pancreas in distal pancreatectomy, in which soft coagulation and polyglycolic acid felt attached with fibrin glue were utilized. Transpancreatic mattress suture with polyglactin 910 woven mesh was recently reported as a novel stump closure technique. We developed the modified transpancreatic mattress suture with polyglactin 910 woven mesh method, which combined our polyglycolic acid felt method with the transpancreatic mattress suture with polyglactin 910 woven mesh method. METHODS The polyglycolic acid felt group included patients undergoing distal pancreatectomy in whom the pancreatic stump was closed with the polyglycolic acid felt method from 2017 to 2018 (n = 54); whereas the modified transpancreatic mattress suture with polyglactin 910 woven mesh group included those whose stump was closed with the modified transpancreatic mattress suture with polyglactin 910 woven mesh method from 2019 to 2020 (n = 51). Perioperative parameters, including grade B/C postoperative pancreatic fistula (clinically relevant postoperative pancreatic fistula), were assessed according to the stump closure method. RESULTS The incidence of clinically relevant postoperative pancreatic fistula was significantly lower in the modified transpancreatic mattress suture with polyglactin 910 woven mesh group than in the polyglycolic acid felt group (7.8% vs 22.2%, P = .036). In multivariate analysis, the use of neoadjuvant chemoradiotherapy and the transpancreatic mattress suture with polyglactin 910 woven mesh method were independent factors for preventing clinically relevant postoperative pancreatic fistula (P = .011 and 0.0038, respectively). Moreover, in the modified transpancreatic mattress suture with polyglactin 910 woven mesh group, the incidence of clinically relevant postoperative pancreatic fistula in patients with a thick pancreas (≥13 mm, 6.7%) was comparably as low as that in patients with a thin pancreas (<13 mm, 9.5%). CONCLUSION The modified transpancreatic mattress suture with polyglactin 910 woven mesh method is an effective stump closure technique to prevent clinically relevant postoperative pancreatic fistula after distal pancreatectomy. Our results warrant further prospective investigation to evaluate the efficacy of the modified transpancreatic mattress suture with polyglactin 910 woven mesh method compared with other standard closure methods (eg, stapler closure or hand-sewn closure).
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Affiliation(s)
- Hiroki Imamura
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Hidenori Takahashi
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan.
| | - Hirofumi Akita
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Hiroshi Wada
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Yosuke Mukai
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Kei Asukai
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Shinichiro Hasegawa
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Yoshiaki Fujii
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Takahito Sugase
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Masaaki Yamamoto
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Tomohira Takeoka
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Naoki Shinno
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Hisashi Hara
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Takashi Kanemura
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Naotsugu Haraguchi
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Junichi Nishimura
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Chu Matsuda
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Masayoshi Yasui
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Takeshi Omori
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Hiroshi Miyata
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Masayuki Ohue
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Masato Sakon
- Department of Surgery, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
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Matsumoto I, Kamei K, Satoi S, Murase T, Matsumoto M, Kawaguchi K, Yoshida Y, Lee D, Takebe A, Nakai T, Takeyama Y. Conversion to open laparotomy during laparoscopic distal pancreatectomy: lessons from a single-center experience in 70 consecutive patients. Surg Today 2020; 51:70-78. [PMID: 32577881 DOI: 10.1007/s00595-020-02056-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to determine the factors influencing conversion from laparoscopic distal pancreatectomy (LDP) to open surgery, and the effect of such conversion on the outcome. METHODS This retrospective single-center study included 70 consecutive patients undergoing LDP. The primary endpoint was the rate of conversion to open surgery during LDP. The secondary endpoints were determining the reasons for conversion to open surgery, with detailed analyses of these cases and a comparison of the surgical outcome with and without conversion. RESULTS Seven patients (10%) required conversion to open surgery during LDP. Pancreatic ductal adenocarcinoma (PDAC) was identified as a risk factor for conversion (p = 0.010). The reasons for conversion included technical difficulty (two bleeding, one severe adhesion) and pancreatic stump-related issues (two margin-positive, two stapling failures). Although the overall morbidity rate (29 vs. 11%, p = 0.48) and the rate of clinically relevant postoperative pancreatic fistula (14 vs. 5%, p = 0.82) were no different for the patients with or without open conversion, the postoperative hospital stay was significantly longer in the former (median 15 vs. 10 days, p = 0.03). CONCLUSIONS Careful preoperative assessment is required when planning LDP for PDAC. Although conversion to open surgery does not result in failure of LDP, efforts to reduce the duration of postoperative hospital stay and the occurrence of complications are desirable to improve the outcome of LDP.
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Affiliation(s)
- Ippei Matsumoto
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Keiko Kamei
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Shumpei Satoi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takaaki Murase
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masataka Matsumoto
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kohei Kawaguchi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuta Yoshida
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Dongha Lee
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Atsushi Takebe
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
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Jiang L, Ning D, Chen X. Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions. Front Med 2019; 14:251-261. [PMID: 31840199 DOI: 10.1007/s11684-019-0727-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/12/2019] [Indexed: 02/08/2023]
Abstract
Postoperative pancreatic fistula (POPF) is the most common and critical complication after pancreatic body and tail resection. How to effectively reduce the occurrence of pancreatic fistula and conduct timely treatment thereafter is an urgent clinical issue to be solved. Recent research standardized the definition of pancreatic fistula and stressed the correlation between POPF classification and patient prognosis. According to the literature, identification of the risk factors for pancreatic fistula contributed to lowering the rate of the complication. Appropriate management of the pancreatic stump and perioperative treatment are of great significance to reduce the rate of POPF in clinical practice. After the occurrence of POPF, the treatment of choice should be determined according to the classification of the pancreatic fistula. However, despite the progress and promising treatment approaches, POPF remains to be a clinical issue that warrants further studies in the future.
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Affiliation(s)
- Li Jiang
- Department of Biliary and Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Deng Ning
- Department of Biliary and Pancreatic Surgery, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaoping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Nishikawa M, Yamamoto J, Hoshikawa M, Einama T, Noro T, Aosasa S, Tsujimoto H, Ueno H, Kishi Y. Stapler sizes optimized for pancreatic thickness can reduce pancreatic fistula incidence after distal pancreatectomy. Surg Today 2019; 50:623-631. [DOI: 10.1007/s00595-019-01929-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022]
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Yoshida Y, Matsumoto I, Matsumoto M, Kawaguchi K, Murase T, Kamei K, Satoi S, Takebe A, Nakai T, Takeyama Y. Transpancreatic mattress suture with Vicryl mesh around the stump decreases postoperative pancreatic fistula after distal pancreatectomy. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2019; 26:510-516. [DOI: 10.1002/jhbp.664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yuta Yoshida
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Ippei Matsumoto
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Masataka Matsumoto
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Kohei Kawaguchi
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Takaaki Murase
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Keiko Kamei
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Shumpei Satoi
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Atsushi Takebe
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Takuya Nakai
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Yoshifumi Takeyama
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
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Abstract
INTRODUCTION Pancreatic trauma results in high morbidity and mortality, in part caused by the delay in diagnosis and subsequent organ dysfunction. Optimal operative management strategies remain unclear. We therefore sought to determine CT accuracy in diagnosing pancreatic injury and the morbidity and mortality associated with varying operative strategies. METHODS We created a multicenter, pancreatic trauma registry from 18 Level 1 and 2 trauma centers. Adult, blunt or penetrating injured patients from 2005 to 2012 were analyzed. Sensitivity and specificity of CT scan identification of main pancreatic duct injury was calculated against operative findings. Independent predictors for mortality, adult respiratory distress syndrome (ARDS), and pancreatic fistula and/or pseudocyst were identified through multivariate regression analysis. The association between outcomes and operative management was measured. RESULTS We identified 704 pancreatic injury patients of whom 584 (83%) underwent a pancreas-related procedure. CT grade modestly correlated with OR grade (r 0.39) missing 10 ductal injuries (9 grade III, 1 grade IV) providing 78.7% sensitivity and 61.6% specificity. Independent predictors of mortality were age, Injury Severity Score (ISS), lactate, and number of packed red blood cells transfused. Independent predictors of ARDS were ISS, Glasgow Coma Scale score, and pancreatic fistula (OR 5.2, 2.6-10.1). Among grade III injuries (n = 158, 22.4%), the risk of pancreatic fistula/pseudocyst was reduced when the end of the pancreas was stapled (OR 0.21, 95% CI 0.05-0.9) compared with sewn and was not affected by duct stitch placement. Drainage alone in grades IV (n = 25) and V (n = 24) injuries carried increased risk of pancreatic fistula/pseudocyst (OR 8.3, 95% CI 2.2-32.9). CONCLUSION CT is insufficiently sensitive to reliably identify pancreatic duct injury. Patients with grade III injuries should have their resection site stapled instead of sewn and a duct stitch is unnecessary. Further study is needed to determine if drainage alone should be employed in grades IV and V injuries. LEVEL OF EVIDENCE Epidemiologic/Diagnostic study, level III.
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Laparoscopic versus open distal pancreatectomy for benign and low-grade malignant lesions of the pancreas: a single-center comparative study. Surg Today 2018; 49:394-400. [DOI: 10.1007/s00595-018-1743-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/11/2018] [Indexed: 01/08/2023]
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Kowalsky SJ, Zenati MS, Dhir M, Schaefer EG, Dopsovic A, Lee KK, Hogg ME, Zeh HJ, Vollmer CM, Zureikat AH. Postoperative narcotic use is associated with development of clinically relevant pancreatic fistulas after distal pancreatectomy. Surgery 2018; 163:747-752. [DOI: 10.1016/j.surg.2017.10.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/02/2017] [Accepted: 10/24/2017] [Indexed: 02/08/2023]
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