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Published in: Surgical Endoscopy 2/2021

01-02-2021 | Pancreatectomy | Dynamic Manuscript

Investigation of intraoperative factors associated with postoperative pancreatic fistula following laparoscopic left pancreatectomy with stapled closure: a video review-based analysis

Video-review for predictors of pancreatic leak

Authors: Giuseppe Zimmitti, Roberta La Mendola, Alberto Manzoni, Valentina Sega, Valentina Malerba, Elio Treppiedi, Claudio Codignola, Lorenzo Monfardini, Marco Garatti, Edoardo Rosso

Published in: Surgical Endoscopy | Issue 2/2021

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Abstract

Introduction

Postoperative pancreatic fistula (POPF) following distal pancreatectomy (DP) remains the most frequent complication, potential precursor of more serious events, and mechanisms behind POPF development are not clear. Primary aim of the current study is to investigate correlations between patients’ characteristics, including technical intraoperative data assessed by retrospective video review of laparoscopic DP (L-PD), and development of clinically relevant (CR-)POPF and major complication.

Methods

Patients undergoing L-DP whose surgery video was available for review were included in this study. Retrospective video review, performed by two surgeons blinded for postoperative outcomes, was focused on pancreatic neck transection and identification of pancreatic capsule disruption (PCD)/staple line bleeding (SLB). Correlation between clinical, demographic, and intraoperative factors and CR-POPF/major complications and assessment of factors associated with PCD and SLB were investigated.

Results

Of 41 L-DP performed at our institution (June 2015–June 2020) using a triple-row stapler (EndoGIA™ Reloads with Tri-Staple™), surgery video was available for 38 patients [men/women, 13/25; median age (range) 62 (25–84) years; median BMI (range) 24 (17–42)]. PCD and SLB occurred in 15(39%) and 19(50%) patients and were concomitant in 9(24%). CR-POPF and major complications occurred in 8(21%) and 12(31%) patients, respectively. PCD, SLB, and PCD + SLB rates were significantly higher among patients with CR-POPF, compared to patients without (all p < 0.05). Among patients with PCD, pancreatic thickness at pancreatic transection site was higher (19 mm), compared to non-PCD patients (13 mm, p < 0.001). A directly proportional relation between PCD, CR-POPF, and major complication rate and pancreatic thickness was confirmed by ROC analysis (AUC = 0.949, 0.798, and 0.740, respectively).

Conclusion

PCD and SLB close to the staple line detected by retrospective video-review are intraoperatively detectable indicators of severe pancreatic traumatism and a potential precursors of CR-POPF following L-PD. Given the strict correlation between PCD and pancreatic thickness, alternative techniques to stapled closure for pancreatic transection may be recommended for patients with a thick pancreas and modification in postoperative care may be considered in patients with PCD/SLB.
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Metadata
Title
Investigation of intraoperative factors associated with postoperative pancreatic fistula following laparoscopic left pancreatectomy with stapled closure: a video review-based analysis
Video-review for predictors of pancreatic leak
Authors
Giuseppe Zimmitti
Roberta La Mendola
Alberto Manzoni
Valentina Sega
Valentina Malerba
Elio Treppiedi
Claudio Codignola
Lorenzo Monfardini
Marco Garatti
Edoardo Rosso
Publication date
01-02-2021
Publisher
Springer US
Keyword
Pancreatectomy
Published in
Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07912-x

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