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

Abstract

Background: Few studies describing the use of stapling devices for uncinate process division during pancreaticoduodenectomy (PD) have data regarding outcomes. Our aim is to discuss our technique and the peri-operative outcomes with the use of the linear vascular stapler for division of the uncinate process during PD. Materials and Methods: 19 consecutive patients who underwent stapler division of the uncinate process (‘stapler’ group) were compared to 20 consecutive patients operated without stapler (‘no-stapler’ group). Results: The overall surgical morbidity in the no-stapler group was 25% (5/20) and 31.6% (6/19) in the stapler group (p = 0.731). The mean blood loss in the no-stapler group was 1,077.5 ± 594 ml compared to 778 ± 302 ml in the stapler group (p = 0.113). The mean operative duration was 498 ± 105 min in the no-stapler group and 490 ± 60 min in the stapler group (p = 0.773). The average number of lymph nodes retrieved was 6.1 ± 3 in the no-stapler group versus 5.9 ± 4 in the stapler group (p = 0.627). Neither group had positive resection margins. Conclusion: Stapler division of the uncinate process for selected periampullary tumours compares well with the conventional method, has comparable peri-operative outcomes without compromising oncological radicality and has the potential to simplify uncinate resection.

Superior mesenteric artery first combined with uncinate process approach versus uncinate process first approach in pancreatoduodenectomy: a comparative study evaluating perioperative outcomes

“…In our study, however, lymph node counts were comparatively similar in both groups and we did not observe any advantage of one technique over the other in terms of lymph nodal harvest. Unfortunately, we have had to report low number of lymph nodes in both groups and at the present time we can only speculate this to be due to pathological sampling and this aspect has been discussed by us in another recent publication [21]. It is obvious that our pathology reporting has not yet been standardized and this can perhaps explain the wide variation in the number of lymph nodes in our series.…”

Centralisation of Pancreatoduodenectomy in India: Where Do We Stand?

“…A total of 36 unique series [9–44] from 24 institutes across India were identified after excluding 18 series [45–62] due to overlap of cases from the same author and institution. Figure 1 depicts the consort chart of the study methodology.…”

Neoadjuvant therapy for pancreas cancer: Global perspective and optimal care pathways in low to middle‐income countries

“…At centers from the HICs that report a mortality rate ranging from 0% to 3%, there was a significant association between higher hospital volume with lesser perioperative complications 29–31 . Data from LMICs is again not encouraging with even higher morbidity (28%–64%) and mortality rates (0%–29%), although better results were reported with high volumes, procedure standardization and service reconfiguration 32–34 . A pattern that could be visualized across the HICs and LMICs is that, service centralization (referral to high‐volume center with expertise) and standardization of procedural protocols can lead to dramatic and significant improvements in the surgery‐specific complications.…”