Surgical loupes at 5.0× magnification and the VIO soft-coagulation system can prevent postoperative pancreatic fistula in duct-to-mucosa pancreaticojejunostomy.
OBJECTIVE
Postoperative pancreatic fistula (POPF) remains a major complication after pancreaticoduodenectomy (PD). In this study, we examined whether our new method using surgical loupes at 5.0× magnification and the VIO soft coagulation system (SC) for duct-to-mucosa pancreaticojejunostomy (PJ) can prevent POPF.


METHODS
A retrospective cohort study was performed in 81 consecutive patients who underwent PD and duct-to-mucosa PJ for periampullary tumors by a single surgeon during a recent 5-year period from 2008 to 2012. These patients were divided into two groups according to the nature of the PJ; the conventional group (n=46) and the 5.0× loupes+SC group (n=35). Short-term surgical results including POPF were compared and an independent risk factor for POPF was identified using the stepwise logistic regression analysis in our series.


RESULTS
The rate of Grade B/C POPF was significantly decreased in the 5.0× loupes+SC group (2.9%) compared to that of the conventional group (9.9%, p=0.04). The absence of 5.0× loupes+SC for PJ was identified as the independent risk factor for Grade B/C POPF (odds ratio, 5.23; p-value, 0.03).


CONCLUSIONS
5.0× surgical loupes+SC for duct-to-mucosa PJ could be used as a novel technique for preventing POPF after PD.
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan yamashi@surg2.med.kyushu-u.ac.jp.
Yo-Ichi
Y
Yamashita
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Yoshihiro
Y
Yoshida
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Takeshi
T
Kurihara
Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.
Eiji
E
Tsujita
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Kazuki
K
Takeishi
Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.
Teruyoshi
T
Ishida
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Tetsuo
T
Ikeda
Department of Gastroenterology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.
Yoshinari
Y
Furukawa
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Ken
K
Shirabe
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Yoshihiko
Y
Maehara
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D015331:Cohort Studies; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008866:Microsurgery / Q000295:instrumentation; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000601:surgery*; D010185:Pancreatic Fistula / Q000517:prevention & control*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*; D012189:Retrospective Studies; D061351:Telescopes
Surgical loups; pancreaticojejunostomy; postoperative pancreatic fistula; soft coagulation