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Langenbeck's Archives of Surgery

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01-12-2013 | Original Article

Continuous irrigation around pancreatic remnant decreases pancreatic fistula-related intraabdominal complications after distal pancreatectomy

Authors: Xianmin Bu, Yongqing Xu, Jin Xu, Xianwei Dai

Published in: Langenbeck's Archives of Surgery | Issue 8/2013

Abstract

Purpose

To evaluate whether the technique of irrigation around pancreatic remnant after distal pancreatectomy (DP) can reduce the incidence of postoperative pancreatic fistula (PF) and its related intraabdominal complications.

Methods

In the retrospective clinical trial, the technique of irrigation around pancreatic remnant after DP was introduced. The clinical data of 60 patients who underwent the irrigation technique (irrigation group) and the other 65 patients who did not undergo the technique (non-irrigation group) were recorded, respectively. Preoperative clinicopathological features, intraoperative parameters, postoperative morbidity, clinically significant PF, and its related intraabdominal complications were compared between the two groups.

Results

The patency of irrigation tubes and drains was maintained in 59 patients. The overall incidence of PF was 31.2 %. There was no significant difference in the rate of PF between the two groups (P = 0.781), but the rate of PF-related intraabdominal complications was significantly lower in the irrigation group than that in the non-irrigation group (5 vs. 18, P = 0.005). The overall incidence of intraabdominal complications was significantly lower in the irrigation group than that in the non-irrigation group (23 vs. 39, P = 0.025).

Conclusion

The technique of irrigation around pancreatic remnant after DP is a simple method for prevention of clinically significant PF and its related intraabdominal complications.

Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698PubMedCrossRef

Fahy BN, Frey CF, Ho HS, Ho HS, Beckett L, Bold RJ (2002) Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 183:237–241PubMedCrossRef

Pannegeon V, Pessaux P, Sauvanet A, Marie-Pierre V, Reza K, Jacques B (2006) Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg 141:1071–1076PubMedCrossRef

Kleeff J, Diener MK, Z'graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Müller MW, Friess H, Büchler MW (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582PubMedCrossRef

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(10):1691–1697PubMedCrossRef

Olah A, Issekutz A, Belayi T, Hajdu N, Jr LR (2009) Randomized clinical trial of techniques for closure of the pancreatic remnant following distal pancreatectomy. Br J Surg 96:602–607PubMedCrossRef

Seeliger H, Christians S, Angele MK, Kleespies A, Eichhorn ME, Ischenko I, Boeck S, Heinemann V, Jauch KW, Bruns CJ (2010) Risk factors for surgical complications in distal pancreatectomy. Am J Surg 200(3):311–317PubMedCrossRef

Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, Yamamoto J, Yamaguchi T (2010) Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 34(1):121–125PubMedCrossRef

Nathan H, Cameron JL, Goodwin CR, Seth AK, Edil BH, Wolfgang CL, Pawlik TM, Schulick RD, Choti MA (2009) Risk factor for pancreatic leak after distal pancreatectomy. Ann Surg 250:277–281PubMedCrossRef

10.

Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92:539–546PubMedCrossRef

11.

Rodríguez JR, Germes SS, Pandharipande PV, Gazelle GS, Thayer SP, Warshaw AL, Fernández-del Castillo C (2006) Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg 141:361–365PubMedCrossRef

12.

Beger HG, Buchler M, Bittner R, Block S, Nevalainen T, Roscher R (1988) Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg 75:207–212PubMedCrossRef

13.

Farkas G, Marton J, Mandi Y, Zederkenyi S (1996) Surgical strategy and management of infected pancreatic necrosis. Br J Surg 83:930–933PubMedCrossRef

14.

Dong X, Gao SL, Xie QP, Xu L, Xu YL, Wu YL (2008) In situ high-volume modified continuous closed and/or open lavage for infected necrotizing pancreatitis. Pancreas 36:44–49PubMedCrossRef

15.

Nakano H, Asakura T, Sakurai J, Koizumi S, Asano T, Watanabe T, Otsubo T (2008) Prophylactic irrigation around a pancreaticojejunostomy for the treatment of a pancreatic fistula after a pancreaticoduodenectomy in patients with a risky pancreatic remnant. Hepatogastroenterology 55(82–83):717–721PubMed

16.

Sawada S, Yamagishi F, Suzuki S, Matsuoha J, Arai H, Tsukada K (2008) Continuous irrigation with suction started at early days after pancreatic surgery prevents severe complications. Hepatogastroenterology 55(82–83):725–728PubMed

17.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRef

18.

Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768PubMedCrossRef

19.

Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH)—an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25PubMedCrossRef

20.

Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, Nakajima H, Kuwano H (2003) Distal pancreatectomy: is staple closure beneficial? ANZ J Surg 73:922–925PubMedCrossRef

21.

Farkas G, Leindler L, Farkas GJR (2005) Safe closure technique for distal pancreatic resection. Langenbecks Arch Surg 390:29–31PubMedCrossRef

22.

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 90:190–196PubMedCrossRef

23.

Suzuki Y, Fujino Y, Tanioka Y, Hori Y, Ueda T, Takeyama Y et al (1999) Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg 86:608–611PubMedCrossRef

24.

Okabayashi T, Kobayashi M, Sugimoto T, Namikawa T, Okamoto K, Hokimoto N, Araki K (2004) Postoperative pancreatic fistula following distal pancreatectomy for pancreatic neoplasm; can pancreatic fistula be prevented? Hepatogastroenterology 51:1838–1841PubMed

25.

Wagner M, Gloor B, Ambühl M, Worni M, Lutz JA, Angst E, Candinas D (2007) Roux-en-Y drainage of the pancreatic stump decreases pancreatic fistula after distal pancreatic resection. J Gastrointest Surg 11:303–308PubMedCrossRef

26.

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 202:77–81PubMedCrossRef

27.

Ohwada S, Ogawa T, Tanahashi Y, Nakamura S, Takeyoshi I, Ohya T, Ikeya T, Kawashima K, Kawashima Y, Morishita Y (1998) Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg 22:494–498PubMedCrossRef

28.

Velanovich V (2007) The use of tissue sealant to prevent fistula formation after laparoscopic distal pancreatectomy. Surg Endosc 21:1222PubMedCrossRef

29.

Thaker RI, Matthews BD, Linehan DC, Strasberg SM, Eagon JC, Hawkons WG (2007) Absorbable mesh reinforcement or a stapled pancreatic transaction line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg 11:59–65PubMedCrossRef

30.

Walters DM, Stokes JB, Adams RB, Bauer TW (2011) Use of a falciform ligament pedicle flap to decrease pancreatic fistula after distal pancreatectomy. Pancreas 20:595–599CrossRef

31.

Kuroki T, Tajima Y, Tsuneoka N, Adachi T, Kanematsu T (2009) Gastric wall-covering method prevents pancreatic fistula after distal pancreatectomy. Hepatogastroenterology 56:877–880PubMed

32.

Moriura S, Kimura A, Ikeda S, Iwatsuka Y, Ikezawa T, Naiki K (1995) Closure of the distal pancreatic stump with a seromuscular flap. Surg Today 25:992–994PubMedCrossRef

33.

Diener MK, Seiler CM, Inga R, Jörg K, Matthias G, Giovanni B, Ales T, Bruns CJ, Busch ORC, Stefan F, Orlin B, Neoptolemos JP, Christopher H, Tobias K, Marco N, Klaus G, Helmut W, Otto K, Peter L, Ulrich S, Jens N, Frederik B, Silke G, Heiss MM, Luntz S e P, Thomas B, Meinhard K, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlledmulticentre trial. Lancet 377:1514–1522PubMedCrossRef

34.

Balzano G, Zerbi A, Cristallo M, Carlo VD (2005) The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg 9:837–842PubMedCrossRef

35.

Yasushi H, William Traverso L (2012) After distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure. J Gastrointest Surg 16:993–1003CrossRef

36.

Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–493PubMedCrossRef

37.

Rau B, Bothe A, Beger HG (2005) Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery 138:28–39PubMedCrossRef

Title: Continuous irrigation around pancreatic remnant decreases pancreatic fistula-related intraabdominal complications after distal pancreatectomy
Authors: Xianmin Bu
Yongqing Xu
Jin Xu
Xianwei Dai
Publication date: 01-12-2013
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-013-1122-1

At a glance: The STEP trials

Springer Medicine

Continuous irrigation around pancreatic remnant decreases pancreatic fistula-related intraabdominal complications after distal pancreatectomy

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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