title: Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy.
abstract: 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.
authors.affiliation: Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa 920-8641, Japan.
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
authors.forename: Takashi
authors.initials: T
authors.lastname: Tani
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Tajima
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Nakagawara
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohnishi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takamura
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
mesh_terms: 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*