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The effectiveness of fish-mouth suture of pancreatic stump for pancreatic leakage by Shuriken shaped umbilicoplasty method in laparoscopic distal pancreatectomy
EAES Academy. Sato Y. 07/05/22; 363132; P177
Dr. Yoshinobu Sato
Dr. Yoshinobu Sato
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Abstract
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Postoperative pancreatic fistula (POPF) following distal pancreatectomy (DP) is a leading contributor to postoperative morbidity & mortality.
Review analysis showed that POPF depend more on underlying patients’ factors than surgical technique. (e.g. obesity, preop nutrition level)
Hence, there is no convincing evidence to support any one transection & closure technique over another in laparoscopic DP. (AIM) Which is better technique for pancreatic transection&closure; Linear stapler or fish-mouth closure? Regarding pancreatic transection & closure, did fish-mouth closure reduce POPF & inpatient stay compared with Echelon linear stapler? (Patients and Method) This is a case-series report. Through the electronic chart we selected retrospectively the 20 patients who underwent laparoscopic DP between May 2019 to Oct 2021 at our institution. The patients of Transect/w Stapler were 10 cases. The patients of Transect/ fish-mouth closure were 10 cases. (Results) Median age of Stapler group was 64 old. That of fish-mouth group was 69 old. BMI were 21.0(19.2-28.5) and 23.0(18.6-31.1) respectively. Thickness of Pancreas on portal vein was 9.95mm(6.74-14.77) and 10.8mm(7.45-15.5) respectively. The cases of POPF over 5000 of drain amylase were 3 patients and those of fish-mouth were 0. Those of post operative psudocyst were 5 and 0 respectively. Blood loss were 90ml and 100ml respectively. Operation time were 321min and 345min respectively. (Conclusions) It is true that this case-series study enrolled limited number of cases, but fish-mouth closure may decrease the risk of POPF and postop pseudocyst compared to stapler. To show superiority of fish-mouth over stapler, case-control study with more power or prospective study is warranted to control confounding factors.
Postoperative pancreatic fistula (POPF) following distal pancreatectomy (DP) is a leading contributor to postoperative morbidity & mortality.
Review analysis showed that POPF depend more on underlying patients’ factors than surgical technique. (e.g. obesity, preop nutrition level)
Hence, there is no convincing evidence to support any one transection & closure technique over another in laparoscopic DP. (AIM) Which is better technique for pancreatic transection&closure; Linear stapler or fish-mouth closure? Regarding pancreatic transection & closure, did fish-mouth closure reduce POPF & inpatient stay compared with Echelon linear stapler? (Patients and Method) This is a case-series report. Through the electronic chart we selected retrospectively the 20 patients who underwent laparoscopic DP between May 2019 to Oct 2021 at our institution. The patients of Transect/w Stapler were 10 cases. The patients of Transect/ fish-mouth closure were 10 cases. (Results) Median age of Stapler group was 64 old. That of fish-mouth group was 69 old. BMI were 21.0(19.2-28.5) and 23.0(18.6-31.1) respectively. Thickness of Pancreas on portal vein was 9.95mm(6.74-14.77) and 10.8mm(7.45-15.5) respectively. The cases of POPF over 5000 of drain amylase were 3 patients and those of fish-mouth were 0. Those of post operative psudocyst were 5 and 0 respectively. Blood loss were 90ml and 100ml respectively. Operation time were 321min and 345min respectively. (Conclusions) It is true that this case-series study enrolled limited number of cases, but fish-mouth closure may decrease the risk of POPF and postop pseudocyst compared to stapler. To show superiority of fish-mouth over stapler, case-control study with more power or prospective study is warranted to control confounding factors.
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