Segmental occlusion of the pancreatic duct with prolamine to prevent fistula formation after distal pancreatectomy.
OBJECTIVE
The authors used prolamine (Ethibloc, Ethicon GmBH, Norderstedt, Germany) for segmental obstruction of the pancreatic duct to prevent pancreatic fistula development after distal pancreatectomy combined with total gastrectomy for gastric malignancies.


BACKGROUND
Although the initial clinical application of prolamine was pancreatic duct obstruction for patients with pancreatitis and undergoing pancreatic transplantation and pancreaticoduodenectomy for pancreatic cancer, there are no reports on prevention of pancreatic fistula formation after distal pancreatectomy.


METHODS
Prolamine (0.2 mL) was injected into the distal segment of the main duct in the remaining pancreata of 51 patients. Small pancreatic ducts on the cut surface, from which prolamine extravasates, were closed by ligation, the main duct was ligated doubly, and the transected pancreatic margin was closed 15 minutes after phenylpropanolamine hydrochloride injection.


RESULTS
No patient developed a pancreatic fistula or the complication of arterial bleeding due to prolonged infection.


CONCLUSIONS
Segmental obstruction of the pancreatic duct with prolamine is useful for preventing pancreatic fistula development after distal pancreatectomy.
Konishi
T
T
Second Department of Surgery, Faculty of Medicine, University of Tokyo, Japan.
Hiraishi
M
M
Kubota
K
K
Bandai
Y
Y
Makuuchi
M
M
Idezuki
Y
Y
D000681:Amylases / Q000097:blood; D003973:Diatrizoate; D004338:Drug Combinations; D005227:Fatty Acids; D005743:Gastrectomy; D005782:Gels; D006801:Humans; D010180:Pancreatectomy; D010183:Pancreatic Ducts; D010185:Pancreatic Fistula / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D011409:Propylene Glycols; D012597:Sclerosing Solutions; D013156:Splenectomy; D013274:Stomach Neoplasms / Q000601:surgery; D015028:Zein
D004338:Drug Combinations; D005227:Fatty Acids; D005782:Gels; D011409:Propylene Glycols; D012597:Sclerosing Solutions; D003973:Diatrizoate; D015028:Zein; C020481:alcoholic prolamine solution; D000681:Amylases