Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue

Akita, Hirofumi; Takahashi, Hidenori; Gotoh, Kunihito; Kobayashi, Shogo; Sugimura, Keijiro; Miyoshi, Norikatsu; Motoori, Masaaki; Noura, Shingo; Fujiwara, Yoshiyuki; Oue, Masayuki; Yano, Masahiko; Sakon, Masato; Ishikawa, Osamu

doi:10.1007/s00423-015-1339-2

Cited by 23 publications

(14 citation statements)

References 33 publications

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“…The incidence of clinically significant POPF (Grade B, C) was 13.3%. POPF rates don’t deviate significantly from DISPACT trial (stapler 32% vs. hand sewn 28%) [ 7 ] and other LDP data [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The most favored and reported techniques are stapler closure vs. hand-sewn closure of the pancreatic remnant. It also includes laparoscopic approaches, radiofrequency-assisted dissection procedure, and biological glue [ 22 , 23 ]. Systematic reviews [ 6 , 8 ] and randomized study [ 7 ] showed that there were no significant differences between stapler closure and hand-sewn closure in POPF.…”

Section: Discussionmentioning

confidence: 99%

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Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon

et al. 2017

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Laparoscopic distal pancreatectomy (LDP) is a safe and reliable treatment for tumors in the body and tail of the pancreas. Postoperative pancreatic fistula (POPF) is a common complication of pancreatic surgery. Despite improvement in mortality, the rate of POPF still remains high and unsolved. To identify risk factors for POPF after laparoscopic distal pancreatectomy, clinicopathological variables on 120 patients who underwent LDP with stapler closure were retrospectively analyzed. Univariate and multivariate analyses were performed to identify risk factors for POPF. The rate of overall and clinically significant POPF was 30.8% and13.3%, respectively. Higher BMI (≥25kg/m2) (p-value = 0.025) and longer operative time (p-value = 0.021) were associated with overall POPF but not clinically significant POPF. Soft parenchymal texture was significantly associated with both overall (p-value = 0.012) and clinically significant POPF (p-value = 0.000). In multivariable analyses, parenchymal texture (OR, 2.933, P-value = 0.011) and operative time (OR, 1.008, P-value = 0.022) were risk factors for overall POPF. Parenchymal texture was an independent predictive factor for clinically significant POPF (OR, 7.400, P-value = 0.001).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon

et al. 2017

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“…POPF is a life-threatening complication that significantly prolongs hospital stay and increases healthcare costs 17 . Substantial effort has been made to prevent pancreatic fistula, such as modifying the surgical procedure and drainage regime, and selecting materials that can minimize the occurrence of POPF 3 – 5 , 18 , 19 ; however, a definitive approach for preventing POPF is still lacking 6 , 7 . Non-resorbable adhesives such as neoprene or prolamine are commonly used in clinical practice to prevent the leakage of pancreatic juice; however, they are limited in that permanent closure can cause pancreatic atrophy and complete loss of exocrine function 20 .…”

Section: Discussionmentioning

confidence: 99%

“…While mortality rates from pancreatic surgery have been declining due to improvements in surgical intervention and medical technology, pancreatic fistula still occurs at a high rate of 10–40% 2 . There are several techniques for preventing leakage of pancreatic secretions, including handsewn sutures, staples 3 , or surgical adhesive materials 4 , 5 . Several materials including fibrin glue and polyglycolic acid felt are widely used in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

Engineered mesenchymal stem-cell-sheets patches prevents postoperative pancreatic leakage in a rat model

Kim

Lee

et al. 2018

Sci Rep

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Post-operative pancreatic fistula (POPF) following pancreatic resection is a life-threatening surgical complication. Cell sheets were prepared and harvested using temperature-responsive culture dishes and transplanted as patches to seal POPF. Two different mesenchymal stem cell (MSC) sheets were compared in terms of the preventative ability for pancreatic leakage in a rat model. Both rat adipose-derived stem cell (rADSC) and bone marrow-derived stem cell (rBMSC) sheets were transplanted. Those rADSC and rBMSC sheets are created without enzymes and thus maintained their cell-cell junctions and adhesion proteins with intact fibronectin on the basal side, as well as characteristics of MSCs. The rats with post-pancreatectomy rADSC- or rBMSC-sheet patches had significantly decreased abdominal fluid leakage compared with the control group, demonstrated by MR image analysis and measurement of the volume of abdominal fluid. Amylase level was significantly lower in the rats with rADSC-sheet and rBMSC-sheet patches compared with the control groups. The rADSC sheet patches had increased adhesive and immune-cytokine profiles (ICAM-1, L-selectin, TIMP-1), and the rBMSC sheets had reduced immune reactions compared to the control. This is first project looking at the feasibility of tissue engineering therapy using MSC-sheets as tissue patches preventing leakage of abdominal fluid caused by POPF.

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“…POPF can be triggered by serious incidents such as intra-abdominal abscess and intra-abdominal arterial bleeding and it can be fatal. To prevent POPF, several techniques including hand-sewn closure [ 8 – 10 ], stapled closure [ 2 , 3 , 8 , 11 , 12 ], main pancreatic duct ligation [ 8 , 10 ], bipolar scissors [ 13 ], the application of fibrin glue [ 14 , 15 ], pancreaticoenteric anastomosis [ 9 , 16 , 17 ], mesh reinforcement of pancreatic transection [ 18 – 20 ], TachoSil ® patches [ 21 ], Teres ligament patch [ 22 ] have been reported. Although the superiority of stapler closure is not clear compared to the other techniques [ 3 , 8 , 12 ], the simple and easy stapler closure method is recently becoming one of the commonly performed techniques.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of postoperative pancreatic fistula after distal pancreatectomy using a triple-row stapler

et al. 2017

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PurposePostoperative pancreatic fistula (POPF) is one of the major complications in patients who undergo distal pancreatectomy (DP). Recently, dividing the pancreas by stapler is a commonly performed technique, however, POPF still occurs. Therefore, the purpose of this study was to investigate the risk factors for POPF after DP using a triple-row stapler.MethodsA total of 75 patients underwent DP using a triple-row stapler (Endo GIA™ Reloads with Tri-Staple™ Technology 60 mm; COVIDIEN, North Haven, CT, USA) at Yamanashi University from December 2012 to December 2016. The clinical risk factors for POPF after DP using a triple-row stapler were identified based on univariate and multivariate analyses.ResultsClinical POPF (ISGPF Grade B and C) was seen in 7 of 75 patients (9.3%). The body mass index (BMI) was significantly higher in the patients with POPF (26.8 ± 0.5 kg/m2) compared with the patients without POPF (21.4 ± 0.4 kg/m2; a cut-off value; 25.7 kg/m2). In addition, the patients with POPF were significantly younger than the patients without POPF (56.4 ± 5.6 vs 67.0 ± 1.5; a cut-off value was 57.0 years old).ConclusionsBMI and age were found to be significant risk factors for POPF after DP using a triple-row stapler.

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Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue

Abstract: Our novel pancreatic stump closure method appears to be simple and effective, particularly in patients with thick pancreas.

Cited by 23 publications

References 33 publications

Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon

Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon

Engineered mesenchymal stem-cell-sheets patches prevents postoperative pancreatic leakage in a rat model

Risk factors of postoperative pancreatic fistula after distal pancreatectomy using a triple-row stapler

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