Top

Published in:

01-03-2019 | Pancreatectomy | Original Article

Pancreatic fistula following laparoscopic distal pancreatectomy is probably unrelated to the stapler size but to the drainage modality and significantly decreased with a small suction drain

Authors: Safi Dokmak, Fadhel Samir Ftériche, Roberto Luca Meniconi, Béatrice Aussilhou, Igor Duquesne, Genaro Perrone, Chihebeddine Romdhani, Jacques Belghiti, Philippe Lévy, Olivier Soubrane, Alain Sauvanet

Published in: Langenbeck's Archives of Surgery | Issue 2/2019

Abstract

Introduction

Risk factors of postoperative pancreatic fistula (POPF) after laparoscopic distal pancreatectomy (LDP) are not well known and were studied, including the stapler cartridge size and drainage modality.

Methods

Between January 2008 and December 2016, 181 LDP were performed and the pancreas was sectioned by stapler in 130 patients (72%). Patients received white (2.5 mm), blue (3.5 mm), or green (4.1 mm) staplers and the size was not based on any pre or peroperative randomization. As primary analysis of the first 84 patients (28 in each group) showed no effect of stapler size on POPF, we decided to use the white (total = 47) or blue and finally the blue (total = 55) of medium size for standardization. Drainage was obtained by multi-tubular drain (first, 79) and a small suction drain (last, 102). Risk factors of POPF were studied and grades B and C were compared to grade A or no POPF.

Results

POPF (n = 66; 36%) was of grade A (n = 25, 14%), grade B (n = 32, 18%), and grade C (n = 9, 5%). The comparison of the three groups of staplers showed that the blue stapler was used more with a small suction drain (85 vs 23%, p < 0.0001), had lower rate of grade B POPF (p = 0.028), and a shorter hospital stay (p = 0.004). On multivariate analysis, only the use of a small suction drain was associated with significant decrease in grades B and C POPF (6 vs 44%, odds ratio 7.385 (1.919–28.418); p = 0.004).

Conclusion

The occurrence of POPF following LDP is influenced by the type of drainage alone and is significantly decreased with a small suction drain.

Kooby DA, Hawkins WG, Schmidt CM et al (2010) A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg 210(5):779–785 786-7CrossRefPubMed

Ricci C, Casadei R, Taffurelli G et al (2015) Laparoscopic versus open distal pancreatectomy for ductal adenocarcinoma: a systematic review and meta-analysis. J Gastrointest Surg 9(4):770–781CrossRef

Kooby DA, Gillespie T, Bentrem D et al (2008) Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg 248(3):438–446PubMed

Venkat R, Edil BH, Schulick RD et al (2012) Laparoscopic distal pancreatectomy is associated with significantly less overall morbidity compared to the open technique: a systematic review and meta-analysis. Ann Surg 255(6):1048–1059CrossRefPubMed

de Rooij T, Jilesen AP, Boerma D et al (2014) A nationwide comparison of laparoscopic and open distal pancreatectomy for benign and malignant disease. J Am Coll Surg 220(3):263–270CrossRefPubMed

Stauffer JA, Rosales-Velderrain A, Goldberg RF et al (2013) Comparison of open with laparoscopic distal pancreatectomy: a single institution's transition over a 7-year period. HPB (Oxford) 15(2):149–155CrossRef

Jin T, Altaf K, Xiong JJ et al (2012) A systematic review and meta-analysis of studies comparing laparoscopic and open distal pancreatectomy. HPB (Oxford) 14(11):711–724CrossRef

Cho CS, Kooby DA, Schmidt CM et al (2011) Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique? Ann Surg 253:975–980CrossRefPubMed

de Rooij T, van Hilst J, van Santvoort H, et al.. (2018) Dutch pancreatic cancer group. Minimally invasive versus open distal pancreatectomy (LEOPARD): a multicenter patient-blinded randomized controlled trial. Ann Surg 269(1):2–9. https://doi.org/10.1097/SLA.0000000000002979

10.

Raoof M, Ituarte PHG, Woo Y et al (2018) Propensity score-matched comparison of oncological outcomes between laparoscopic and open distal pancreatic resection. Br J Surg 105(5):578–586CrossRefPubMedPubMedCentral

11.

Kleeff J, Diener MK, Z'graggen K et al (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582CrossRefPubMedPubMedCentral

12.

Lillemoe KD, Kaushal S, Cameron JL et al (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698CrossRefPubMedPubMedCentral

13.

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(2):190–196CrossRefPubMed

14.

Pannegeon V, Pessaux P, Sauvanet A et al (2006) Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg 141(11):1071–1076 discussion 1076CrossRefPubMed

15.

Dokmak S, Aussilhou B, Ftériche FS et al (2017) Hanging maneuver for stomach traction in laparoscopic distal pancreatic resections: an original technique applied in 218 patients. Dig Surg 34(2):89–94CrossRefPubMed

16.

Warshaw AL (1988) Conservation of the spleen with distal pancreatectomy. Arch Surg 123(5):550–553CrossRefPubMed

17.

Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed

18.

Diener MK, Seiler CM, Rossion I et al (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet 377:1514–1522CrossRefPubMed

19.

Montorsi M, Zerbi A, Bassi C, Italian Tachosil Study Group et al (2012) Efficacy of an absorbable fibrin sealant patch (TachoSil) after distal pancreatectomy: a multicenter, randomized, controlled trial. Ann Surg 256(5):853–859 discussion 859–60CrossRefPubMed

20.

Sa Cunha A, Carrere N, Meunier B et al (2015) Stump closure reinforcement with absorbable fibrin collagen sealant sponge (TachoSil) does not prevent pancreatic fistula after distal pancreatectomy: the FIABLE multicenter controlled randomized study. Am J Surg 210(4):739–748CrossRefPubMed

21.

Park JS, Lee DH, Jang JY et al (2016) Use of TachoSil(®) patches to prevent pancreatic leaks after distal pancreatectomy: a prospective, multicenter, randomized controlled study. J Hepatobiliary Pancreat Sci 23(2):110–117 dCrossRefPubMed

22.

Butturini G, Damoli I, Crepaz L et al (2015) A prospective non-randomised single-center study comparing laparoscopic and robotic distal pancreatectomy. Surg Endosc 29(11):3163–3170CrossRefPubMed

23.

Kim H, Jang JY, Son D et al (2016) Optimal stapler cartridge selection according to the thickness of the pancreas in distal pancreatectomy. Medicine (Baltimore) 95(35):e4441CrossRef

24.

Yoshioka R, Saiura A, Koga R et al (2010) Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 34(1):121–125CrossRefPubMed

25.

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(10):956–965CrossRefPubMed

26.

Subhedar PD, Patel SH, Kneuertz PJ et al (2011) Risk factors for pancreatic fistula after stapled gland transection. Am Surg 77(8):965–970PubMed

27.

Distler M, Kersting S, Rückert F et al (2014) Chronic pancreatitis of the pancreatic remnant is an independent risk factor for pancreatic fistula after distal pancreatectomy. BMC Surg 14:54CrossRefPubMedPubMedCentral

28.

Chang YR, Kang JS, Jang JY et al (2017) Prediction of pancreatic fistula after distal pancreatectomy based on cross-sectional images. World J Surg 41(6):1610–1617CrossRefPubMed

29.

Arai T, Kobayashi A, Yokoyama T et al (2015) Signal intensity of the pancreas on magnetic resonance imaging: prediction of postoperative pancreatic fistula after a distal pancreatectomy using a triple-row stapler. Pancreatology 15(4):380–386CrossRefPubMed

30.

Takahashi H, Ogawa H, Ohigashi H et al (2011) Preoperative chemoradiation reduces the risk of pancreatic fistula after distal pancreatectomy for pancreatic adenocarcinoma. Surgery 150(3):547–556CrossRefPubMed

31.

Frozanpor F, Lundell L, Segersvärd R et al (2012) The effect of prophylactic transpapillary pancreatic stent insertion on clinically significant leak rate following distal pancreatectomy: results of a prospective controlled clinical trial. Ann Surg 255(6):1032–1036CrossRefPubMed

32.

Allen PJ, Gönen M, Brennan MF et al (2014) N Engl J Med 370(21):2014–2022CrossRefPubMed

33.

Jang JY, Shin YC, Han Y, et al. (2016) Effect of polyglycolic acid mesh for prevention of pancreatic fistula following distal pancreatectomy: a randomized clinical trial. JAMA Surg 152(2):150–155. https://doi.org/10.1001/jamasurg.2016.3644

34.

Oláh A, Issekutz A, Belágyi T et al (2009) Randomized clinical trial of techniques for closure of the pancreatic remnant following distal pancreatectomy. Br J Surg 96(6):602–607CrossRefPubMed

35.

Carter TI, Fong ZV, Hyslop T et al (2013) A dual-institution randomized controlled trial of remnant closure after distal pancreatectomy: does the addition of a falciform patch and fibrin glue improve outcomes? J Gastrointest Surg 17(1):102–109CrossRefPubMed

36.

Klein F, Glanemann M, Faber W et al (2012) Pancreatoenteral anastomosis or direct closure of the pancreatic remnant after a distal pancreatectomy: a single-centre experience. HPB (Oxford) 14(12):798–804CrossRef

37.

Hassenpflug M, Hinz U, Strobel O et al (2016) Teres ligament patch reduces relevant morbidity after distal pancreatectomy (the DISCOVER randomized controlled trial). Ann Surg 264(5):723–730CrossRefPubMed

38.

Kah Heng CA, Salleh I, San TS et al (2010) Pancreatic fistula after distal pancreatectomy: incidence, risk factors and management. ANZ J Surg 80(9):619–623CrossRefPubMed

39.

Harris LJ, Abdollahi H, Newhook T et al (2010) Optimal technical management of stump closure following distal pancreatectomy: a retrospective review of 215 cases. J Gastrointest Surg 14:998–1005CrossRefPubMed

40.

Ferrone CR, Warshaw AL, Rattner DW et al (2008) Pancreatic fistula rates after 462 distal pancreatectomies. Stapler do not decrease fistula rates. J Gastrointest Surg 12:1691–1698CrossRefPubMedPubMedCentral

41.

Sugimoto M, Gotohda N, Kato Y et al (2013) Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use. J Hepatobiliary Pancreat Sci 20(5):538–544CrossRefPubMed

42.

Jensen EH, Portschy PR, Chowaniec J et al (2013) Meta-analysis of bioabsorbable staple line reinforcement and risk of fistula following pancreatic resection. J Gastrointest Surg 17(2):267–272CrossRefPubMed

43.

Hamilton NA, Porembka MR, Johnston FM et al (2012) Mesh reinforcement of pancreatic transection decreases incidence of pancreatic occlusion failure for left pancreatectomy: a single-blinded, randomized controlled trial. Ann Surg 255(6):1037–1042CrossRefPubMed

44.

Mendoza AS 3rd, Han HS, Ahn S et al (2016) Predictive factors associated with postoperative pancreatic fistula after laparoscopic distal pancreatectomy: a 10-year single-institution experience. Surg Endosc 30(2):649–656CrossRefPubMed

45.

Sepesi B, Moalem J, Galka E et al (2012) The influence of staple size on fistula formation following distal pancreatectomy. J Gastrointest Surg 16(2):267–274CrossRefPubMed

46.

Paulus EM, Zarzaur BL, Behrman SW (2012) Routine peritoneal drainage of the surgical bed after elective distal pancreatectomy: is it necessary? Am J Surg 204(4):422–427CrossRefPubMed

47.

Adham M, Chopin-Laly X, Lepilliez V et al (2013) Pancreatic resection: drain or no drain? Surgery 154(5):1069–1077CrossRefPubMed

48.

Behrman SW, Zarzaur BL, Parmar A et al (2015) Routine drainage of the operative bed following elective distal pancreatectomy does not reduce the occurrence of complications. J Gastrointest Surg 19(1):72–79 discussion 79CrossRefPubMed

49.

Van Buren G 2nd, Bloomston M, Schmidt CR et al (2017) A prospective randomized multicenter trial of distal pancreatectomy with and without routine intraperitoneal drainage. Ann Surg 266(3):421–431CrossRefPubMed

50.

Sierzega M, Kulig P, Kolodziejczyk P et al (2013) Natural history of intra-abdominal fluid collections following pancreatic surgery. J Gastrointest Surg 17(8):1406–1413CrossRefPubMedPubMedCentral

51.

Tjaden C, Hinz U, Hassenpflug M et al (2016) Fluid collection after distal pancreatectomy: a frequent finding. HPB (Oxford) 18(1):35–40CrossRef

52.

Zureikat AH, Moser AJ, Boone BA et al (2013) 250 robotic pancreatic resections: safety and feasibility. Ann Surg 258(4):554–559 discussion 559–62CrossRefPubMed

53.

Sadot E, Brennan MF, Lee SY et al (2014) Readmission after pancreatic resection: causes and causality pattern. Ann Surg Oncol 21(13):4342–4350CrossRefPubMedPubMedCentral

Title: Pancreatic fistula following laparoscopic distal pancreatectomy is probably unrelated to the stapler size but to the drainage modality and significantly decreased with a small suction drain
Authors: Safi Dokmak
Fadhel Samir Ftériche
Roberto Luca Meniconi
Béatrice Aussilhou
Igor Duquesne
Genaro Perrone
Chihebeddine Romdhani
Jacques Belghiti
Philippe Lévy
Olivier Soubrane
Alain Sauvanet
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Keyword: Pancreatectomy
Published in: Langenbeck's Archives of Surgery / Issue 2/2019
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-019-01756-3

At a glance: The STEP trials

Springer Medicine

Pancreatic fistula following laparoscopic distal pancreatectomy is probably unrelated to the stapler size but to the drainage modality and significantly decreased with a small suction drain

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2019

Malignant colorectal polyps: endoscopic polypectomy and watchful waiting is not inferior to subsequent bowel resection. A nationwide propensity score-based analysis

Mortality and postoperative complications after different types of surgical reconstruction following pancreaticoduodenectomy—a systematic review with meta-analysis

Management of post-pancreatectomy haemorrhage using resuscitative endovascular balloon occlusion of the aorta

Dislocation of intra-abdominal drains after pancreatic surgery: results of a prospective observational study

The influence of diverting loop ileostomy vs. colostomy on postoperative morbidity in restorative anterior resection for rectal cancer: a systematic review and meta-analysis

Functional outcome after pouch-anal reconstruction with primary and secondary mucosectomy for patients with familial adenomatous polyposis (FAP)