Totally laparoscopic stapled distal pancreatectomy.
OBJECTIVE
To evaluate the outcomes of totally laparoscopic distal pancreatectomy (LDP).


METHODS
A prospective database of patients treated within a single institution was studied retrospectively. Between March 2003 and January 2010, 15 patients underwent pancreatic transection with the use of a stapler, followed by sealing of the pancreatic stump with fibrin-coated collagen fleece (TachoComb) in LDP.


RESULTS
LDP was completed successfully in all 15 patients. The median operating time and blood loss were 168 min (range 105-213 min) and 36 ml (range 12-89 ml), respectively. The median drain amylase level peaked at 969 IU/l (93-3077 IU/l) on postoperative day (POD) 1, and then dropped to 165 IU/l (30-846 IU/l) on POD 3. The median hospital stay was 7 days (range 4-15 days). Biochemical pancreatic leaks developed in three patients (20 %), but there was no clinical pancreatic fistula or postoperative hemorrhage.


CONCLUSIONS
Our study shows that the combined use of a stapler and TachoComb decreased the incidence of pancreatic fistulas after LDP. This procedure offers more efficient and consistent results than those achieved by closing the pancreatic stump by stapling alone.
Department of Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka 020-8505, Japan. hkataji@live.jp
Hirokatsu
H
Katagiri
Akira
A
Sasaki
Hiroyuki
H
Nitta
Takeshi
T
Takahara
Satoshi
S
Nishizuka
Go
G
Wakabayashi
D000328:Adult; D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005340:Fibrinogen / Q000008:administration & dosage*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000295:instrumentation / Q000379:methods*; D010182:Pancreatic Diseases / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000295:instrumentation / Q000379:methods*; D013917:Thrombin / Q000008:administration & dosage*; D014014:Tissue Adhesives / Q000008:administration & dosage*; D016896:Treatment Outcome
D004338:Drug Combinations; D014014:Tissue Adhesives; C093991:tachocomb; D005340:Fibrinogen; D007611:Aprotinin; D013917:Thrombin