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Published in: World Journal of Surgery 5/2010

01-05-2010

LigaSure for Pancreatic Sealing During Distal Pancreatectomy

Authors: Werner Hartwig, Martin Duckheim, Oliver Strobel, Dmitry Dovzhanskiy, Frank Bergmann, Thilo Hackert, Markus W. Büchler, Jens Werner

Published in: World Journal of Surgery | Issue 5/2010

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Abstract

Background

Pancreatic fistula is an unresolved problem after distal pancreatectomy. The current study investigated the safety of LigaSure for distal pancreatic resection in a porcine model.

Methods

A distal pancreatectomy was performed in 22 pigs. Animals were randomly assigned to undergo conventional scalpel transection with hand-sewn closure of the pancreatic remnant or pancreatic transection and sealing by LigaSure. Closed-suction drainage was collected daily. Animals were sacrificed on postoperative day (POD) 7 and the pancreatic remnant was sampled for histology.

Results

Two grade A postoperative temporary pancreatic fistulas (ISGPF definition) developed after hand suturing but none after LigaSure sealing. Amylase and lipase levels in drainage fluid were higher in the suture group during the first postoperative days but showed no differences after the fourth day. All but two animals that had to be euthanized because of small bowel invagination survived until POD 7. No significant differences were found in macroscopic changes between groups at reexploration. Histology demonstrated focal, chronic granulating inflammation with minor necrosis in all animals.

Conclusions

The LigaSure sealing device provides a safe alternative to conventional hand-sewn closure of the pancreatic stump in distal pancreatectomy. This is the first study that investigated this effective and highly applicable technique for pancreatic transection.
Literature
1.
go back to reference Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed
2.
go back to reference Kleeff J, Diener MK, Z’graggen K et al (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582CrossRefPubMed Kleeff J, Diener MK, Z’graggen K et al (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582CrossRefPubMed
3.
go back to reference Diener MK, Knaebel HP, Witte ST et al (2008) DISPACT trial: a randomized controlled trial to compare two different surgical techniques of DIStal PAnCreaTectomy—study rationale and design. Clin Trials 5:534–545CrossRefPubMed Diener MK, Knaebel HP, Witte ST et al (2008) DISPACT trial: a randomized controlled trial to compare two different surgical techniques of DIStal PAnCreaTectomy—study rationale and design. Clin Trials 5:534–545CrossRefPubMed
4.
go back to reference Melotti G, Butturini G, Piccoli M et al (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82CrossRefPubMed Melotti G, Butturini G, Piccoli M et al (2007) Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg 246:77–82CrossRefPubMed
5.
go back to reference Sa Cunha A, Rault A, Beau C et al (2008) A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 143:289–295CrossRefPubMed Sa Cunha A, Rault A, Beau C et al (2008) A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg 143:289–295CrossRefPubMed
6.
go back to reference Fernandez-Cruz L, Cosa R, Blanco L et al (2007) Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg 11:1607–1621CrossRefPubMed Fernandez-Cruz L, Cosa R, Blanco L et al (2007) Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg 11:1607–1621CrossRefPubMed
7.
go back to reference Saiura A, Yamamoto J, Koga R et al (2006) Usefulness of LigaSure for liver resection: analysis by randomized clinical trial. Am J Surg 192:41–45CrossRefPubMed Saiura A, Yamamoto J, Koga R et al (2006) Usefulness of LigaSure for liver resection: analysis by randomized clinical trial. Am J Surg 192:41–45CrossRefPubMed
8.
go back to reference Ikeda M, Hasegawa K, Sano K et al (2009) The vessel sealing system (LigaSure) in hepatic resection: a randomized controlled trial. Ann Surg 250(2):199–203CrossRefPubMed Ikeda M, Hasegawa K, Sano K et al (2009) The vessel sealing system (LigaSure) in hepatic resection: a randomized controlled trial. Ann Surg 250(2):199–203CrossRefPubMed
9.
go back to reference Shigemura N, Akashi A, Nakagiri T et al (2004) A new tissue-sealing technique using the Ligasure system for nonanatomical pulmonary resection: preliminary results of sutureless and stapleless thoracoscopic surgery. Ann Thorac Surg 77:1415–1418CrossRefPubMed Shigemura N, Akashi A, Nakagiri T et al (2004) A new tissue-sealing technique using the Ligasure system for nonanatomical pulmonary resection: preliminary results of sutureless and stapleless thoracoscopic surgery. Ann Thorac Surg 77:1415–1418CrossRefPubMed
10.
go back to reference Kraft W, Dürr U (eds) (1995) Klinische Labordiagnostik in der Tiermedizin. Schattauer, Stuttgart, New York, pp 122–123 Kraft W, Dürr U (eds) (1995) Klinische Labordiagnostik in der Tiermedizin. Schattauer, Stuttgart, New York, pp 122–123
11.
go back to reference Ferrone CR, Warshaw AL, Rattner DW et al (2008) Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg 12:1691–1697CrossRefPubMed Ferrone CR, Warshaw AL, Rattner DW et al (2008) Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg 12:1691–1697CrossRefPubMed
12.
go back to reference Kajiyama Y, Tsurumaru M, Udagawa H et al (1996) Quick and simple distal pancreatectomy using the GIA stapler: report of 35 cases. Br J Surg 83:1711CrossRefPubMed Kajiyama Y, Tsurumaru M, Udagawa H et al (1996) Quick and simple distal pancreatectomy using the GIA stapler: report of 35 cases. Br J Surg 83:1711CrossRefPubMed
13.
go back to reference Lillemoe KD, Kaushal S, Cameron JL et al (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698CrossRefPubMed Lillemoe KD, Kaushal S, Cameron JL et al (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698CrossRefPubMed
14.
go back to reference Bilimoria MM, Cormier JN, Mun Y et al (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196CrossRefPubMed Bilimoria MM, Cormier JN, Mun Y et al (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196CrossRefPubMed
15.
go back to reference 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 143:956–965CrossRefPubMed 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 143:956–965CrossRefPubMed
16.
go back to reference Wagner M, Gloor B, Ambuhl M et al (2007) Roux-en-Y drainage of the pancreatic stump decreases pancreatic fistula after distal pancreatic resection. J Gastrointest Surg 11:303–308CrossRefPubMed Wagner M, Gloor B, Ambuhl M et al (2007) Roux-en-Y drainage of the pancreatic stump decreases pancreatic fistula after distal pancreatic resection. J Gastrointest Surg 11:303–308CrossRefPubMed
17.
go back to reference Moriura S, Kimura A, Ikeda S et al (1995) Closure of the distal pancreatic stump with a seromuscular flap. Surg Today 25:992–994CrossRefPubMed Moriura S, Kimura A, Ikeda S et al (1995) Closure of the distal pancreatic stump with a seromuscular flap. Surg Today 25:992–994CrossRefPubMed
18.
go back to reference Iannitti DA, Coburn NG, Somberg J et al (2006) Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique. J Am Coll Surg 203:857–864CrossRefPubMed Iannitti DA, Coburn NG, Somberg J et al (2006) Use of the round ligament of the liver to decrease pancreatic fistulas: a novel technique. J Am Coll Surg 203:857–864CrossRefPubMed
19.
go back to reference Suzuki Y, Kuroda Y, Morita A et al (1995) Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Arch Surg 130:952–955PubMed Suzuki Y, Kuroda Y, Morita A et al (1995) Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Arch Surg 130:952–955PubMed
Metadata
Title
LigaSure for Pancreatic Sealing During Distal Pancreatectomy
Authors
Werner Hartwig
Martin Duckheim
Oliver Strobel
Dmitry Dovzhanskiy
Frank Bergmann
Thilo Hackert
Markus W. Büchler
Jens Werner
Publication date
01-05-2010
Publisher
Springer-Verlag
Published in
World Journal of Surgery / Issue 5/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-010-0458-8

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