A simple and safe pancreas transection using a stapling device for a distal pancreatectomy

Abstract

Pancreatic fistula is the most common major complication to occur after distal pancreatectomy, ranging in frequency from 5% to 40%. The appropriate technique for treating the pancreatic stump still remains controversial. Thirty-six patients underwent distal pancreatectomy in Kagawa University Hospital between January 2000 and February 2007. Their hospital records were reviewed to evaluate the usefulness of a stapling closure using several types of staplers in comparison to a suture closure. They were subdivided according to the method used to close the pancreas stump: the suture group comprised 11 patients, the staple group comprised 24 patients, including 7 patients for whom was used the new endopath stapler Echelon 60 (Ethicon Endo-surgery; Johnson & Johnson, Cincinnati, OH, USA). Overall pancreatic fistula rate was 17% (6/36) in this series. In the staple group, 3 of the 24 patients (12%) developed a pancreatic fistula, whereas in the suture group, 3 of 11 patients (27%) developed a pancreatic fistula. Of the 7 patients for whom the Echelon 60 was used, none developed a pancreatic fistula. The length of postoperative hospital stay was also significantly shorter for the patients with the Echelon 60 than in the patients either with sutures or another stapling device. These findings support the advantages of using a stapler closure in distal pancreatectomy. This method, using a new stapler device, is considered to be a simple and safe alternative to the standard suture closure technique.

A Thick Pancreas Is a Risk Factor for Pancreatic Fistula after a Distal Pancreatectomy: Selection of the Closure Technique according to the Thickness

“…Okano et al [15] noted that the most important and technically difficult step of a stapler dissection was to prevent the pancreatic tissue from tearing during compression. Therefore, they clamped the stapler jaw carefully and slowly over more than 5 min at a fixed speed.…”

“…During the 2nd period, the pancreas was transected using the echelon 60 linear stapler (Ethicon Endo-Surgery; Johnson & Johnson, Tokyo, Japan). The closure jaw was clamped carefully and slowly, taking more than 5 min at a fixed speed [15]. All patients underwent a splenectomy.…”

Distal Pancreatectomy Utilizing a Flexible Stapler Closure Eliminates the Risk of Pancreas-Related Factors for Postoperative Pancreatic Fistula

“…Recently, there has been a trend towards favoring stapler closure rather than hand-sewn closure for the pancreas. Various stapling devices are available for use in pancreatic surgery to divide the pancreatic parenchyma, and their convenience and usefulness have been reported [5,6,7,8]. However, the incidence of PF after DP with the use of stapling devices is varied, being reported to range from 5 to 60% [1,9,10,11,12,13,14], and the risk factors for PF as well as the criterion for stapler selection are still unclear.…”

The Vascular Stapler in Uncinate Process Division during Pancreaticoduodenectomy: Technical Considerations and Results

“…The use of stapling devices has achieved widespread application in gastro-intestinal and hepatopancreatobiliary surgery and has led to greatly reduced operative times and standardization of techniques [19,20]. In particular, in pancreatic surgery the use of the stapler in distal pancreatectomy has been reported extensively in the literature [6,7,8,9,10,11]. However, only a few papers describe the use of the stapler for the division of the uncinate process during performance of a PD [12,13,14,15,16].…”

“…In the past, several techniques have been employed to simplify and reduce bleeding during this part of the operation including the use of a saline-linked radio frequency device [4,5]. While a number of studies have described the use of surgical staplers in distal pancreatectomy and division of the neck of the pancreas during a PD [6,7,8,9,10,11] specifically, only a few studies have described the utility of stapling devices in division of the uncinate process during PD [12,13,14,15,16]. Most studies are technique papers and do not provide the peri-operative outcomes and morbidity data; some concluded that generating objective peri-operative data was the next step in evaluating the technique they described.…”