title: Surgical management for the reduction of postoperative hospital stay following distal pancreatectomy.
abstract: OBJECTIVE
  Pancreatic fistula remains a major cause of postoperative morbidity in patients undergoing pancreatectomy and is generally difficult to cure. None of the several surgical techniques and devices available for managing pancreatic remnant have been clinically evaluated.
  
  
  METHODS
  We retrospectively reviewed medical records of 120 consecutive patients who underwent distal pancreatectomy at our institution between October 1992 and September 2009. Furthermore, we divided these cases into 3 periods based on 2 points at which we changed our surgical strategy. One was September 2004, when we introduced a stapling technique for managing remnant pancreas. The other was November 2006, when we started using a closed active drain. We evaluated the incidence of pancreatic fistula, risk factors for its development, and our strategy in the perioperative period.
  
  
  RESULTS
  The overall and clinical pancreatic fistula rates gradually decreased but were not significant. The persistent drainage period gradually reduced from 19 days to 8 days (p=0.071) over a time period. Postoperative hospital stay was significantly reduced from 24 days to 14 days (p=0.026).
  
  
  CONCLUSIONS
  Utilization of a stapling technique and closed active drain significantly reduces postoperative hospital stay.
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, National Cancer Center East Hospital, Chiba, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshikawa
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D010185:Pancreatic Fistula / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*