title: Improved rate of pancreatic fistula after distal pancreatectomy: parenchymal division with the use of saline-coupled radiofrequency ablation.
abstract: BACKGROUND
  Postoperative pancreatic fistula (POPF) is the most common significant complication after distal pancreatectomy (DP) and results in substantial morbidity. Many different methods are available to divide the pancreatic parenchyma and achieve stump closure, but demonstrating an improvement in the incidence of POPF has been difficult.
  
  
  METHODS
  A single-institution, retrospective review was conducted to evaluate all hand-assisted laparoscopic DP performed from October 2008 to July 2011 utilizing saline-coupled radiofrequency ablation (RFA) as the exclusive method of achieving division of the pancreatic parenchyma and closure of the proximal pancreatic remnant. All significant complications within the perioperative period were noted.
  
  
  RESULTS
  Thirty-four patients met the criteria for inclusion in the study. One patient was lost to follow-up and thus excluded. Three patients (9.1%) demonstrated a POPF; two were treated with prolonged placement of the intraoperative drain (grade A: 6.1%) and the third was treated with endoscopic cystogastrostomy (grade C: 3.0%). One other significant complication (3.0%) of a perforated gastric ulcer that required partial gastrectomy occurred.
  
  
  CONCLUSIONS
  The use of saline-coupled RFA alone for pancreatic parenchymal division and closure after DP is safe and effective. This study found an overall significant complication rate of 6.1%, and a rate of clinically significant POPF of 3.0%.
authors: Department of Surgery, University of South Alabama Cancer Surgery of Mobile, PC, AL, USA.
authors: Jack W
authors: JW
authors: Rostas
authors: William O
authors: WO
authors: Richards
authors: Lee W
authors: LW
authors: Thompson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000407:Alabama; D017115:Catheter Ablation / Q000009:adverse effects; D004322:Drainage; D005260:Female; D005743:Gastrectomy; D058733:Hand-Assisted Laparoscopy / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control* / Q000601:surgery; D010439:Peptic Ulcer Perforation / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult