[A novel technique for the closure of the pancreatic remnant using jejunal serosa following distal pancreatectomy].
Postoperative complication rate after distal pancreatectomy is as high as 10-30% in the published literature. Intraabdominal abscess formation and pancreatic fistula are the most common and clinically relevant complications, and they are thought to depend on surgical technique and skills. Using a novel method, we covered the pancreatic stump with the serosal surface of the first jejunal loop. Our aim was to compare the efficacy of this new technique to the traditional "stapling and handsewn suturing" method in terms of postoperative complication rate. Between 2002 and 2005, 50 patients, who underwent distal pancreatectomy, were randomized prospectively into two groups. In the first group of patients (n=23) the remnant of the pancreas was closed by the novel technique using the serosal surface of the first jejunal loop. In the second group (n=27) the pancreatic stump was closed in the traditional way using a combination of stapler and handsewn suture method. The incidence of postoperative pancreatic fistula and/or intra-abdominal abscess formation were compared using Fischer's test. Pancreatic fistula was defined as a loss of greater than 100 ml fluid drainage beyond postoperative day 5. We found a significantly lower postoperative complication rate using the novel technique compared to the traditional way to cover the pancreatic stump after distal pancreatectomy (8.7% vs. 33% (P = 0.0458). However, there was no significant difference in postoperative hospital stay. We concluded that using the serosal surface of the first jejunal loop is a simple, quick and secure method of closure of the proximal pancreas in terms of surgical practicability. This new technique significantly decreases the rate of postoperative fistula or abscess formation after distal pancreatectomy.
Issekutz
Akos
A
Sebészeti Osztály, Petz Aladár Megyei Oktató Kórház, Gyor. aqusius@hotmail.com
Belágyi
Tibor
T
Romics
Lászlo
L
Oláh
Attila
A
D018784:Abdominal Abscess / Q000209:etiology / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D012704:Serous Membrane / Q000601:surgery* / Q000637:transplantation; D013528:Surgical Staplers; D013536:Suture Techniques