Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy.
OBJECTIVE
Management of the pancreatic remnant after distal pancreatectomy is still debated, the most serious complication is development of a pancreatic fistula. We developed a nonclosure technique with saline-coupled bipolar electrocautery for preventing fistula formation after distal pancreatectomy as an alternative to traditional stump closure methods.


METHODS
The distinguishing feature of this technique is nonclosure of the stump, relying instead upon dependable ligation of the main pancreatic duct and sealing of the cut surface by shrinkage accomplished by low-temperature coagulation using saline-coupled bipolar electrocautery. A recent addition has been intraoperative stenting of the remnant pancreatic duct.


RESULTS
To date we have used the nonclosure technique in 40 cases, among which 5 (12.5%) developed fistulas: 4 in the nonstenting subgroup (14.8%) and 1 in the stenting subgroup (7.7%). According to a recent classification, 4 fistulas were considered grade A; 1, grade B; and 0, grade C. The grade B patient did not undergo stenting.


CONCLUSIONS
Our preliminary experience should prompt more widespread evaluation of the nonclosure technique.
Kitagawa
Hirohisa
H
Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
Ohta
Tetsuo
T
Tani
Takashi
T
Tajima
Hidehiro
H
Nakagawara
Hisatoshi
H
Ohnishi
Ichiro
I
Takamura
Hiroyuki
H
Kayahara
Masato
M
D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008026:Ligation; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts / Q000098:blood supply / Q000601:surgery; D010185:Pancreatic Fistula / Q000517:prevention & control*