title: Laparoscopic Distal Pancreatectomy Using the Modified Prolonged Prefiring Compression Technique Reduces Pancreatic Fistula.
abstract: BACKGROUND
  Pancreatic fistula (PF) is a common postoperative complication following distal pancreatectomy. The prolonged prefiring compression (PFC) technique to reduce PF has been described by Nakamura and colleagues in Japan. The present study assessed if this technique can be applied to the United Kingdom patient population in a tertiary referral center and replicate the low incidence of PF after the laparoscopic approach to distal pancreatectomy (Lap-DP).
  
  
  METHODS
  This is a retrospective study of all patients who underwent Lap-DP using the modified PFC technique by the senior author between June 2011 and July 2014. The modified PFC technique involved compression of the pancreatic parenchyma with an endo-stapler for a 3-minute period prior to firing and further 1-minute compression after firing prior to removal of the stapler, which is a small variant to the original technique of maintaining a 2-minute compression post firing.
  
  
  RESULTS
  Twenty patients (15 females; median age, 66 [range, 25-77] years) underwent Lap-DP using the PFC technique during the study period. Six patients had splenic-preserving Lap-DP. Median operating time was 240 minutes (range, 150-420 minutes) with a median length of hospital stay of 6 days (range, 3-22 days). Six patients (30%) developed Type A (biochemically noted as high drain fluid amylase) PF, and none of the patients had Type B/C PF. In the splenic preservation group, 1 patient had complete splenic infarction requiring laparoscopic splenectomy on Day 3, and 1 patient had partial infarction requiring prolonged hospital stay for pain relief. One patient required prolonged respiratory support due to severe preexisting lung disease. Overall mortality was zero.
  
  
  CONCLUSIONS
  Our data confirm that the PFC technique is safe, feasible, and effective in reducing clinically significant PF post-Lap-DP in the United Kingdom patient population.
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust , Plymouth, United Kingdom .
authors.forename: Arun V
authors.initials: AV
authors.lastname: Ariyarathenam
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust , Plymouth, United Kingdom .
authors.forename: David
authors.initials: D
authors.lastname: Bunting
authors.affiliation: Peninsula HPB Unit, Derriford Hospital, Plymouth Hospitals NHS Trust , Plymouth, United Kingdom .
authors.forename: Somaiah
authors.initials: S
authors.lastname: Aroori
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D011312:Pressure / Q000009:adverse effects; D012189:Retrospective Studies; D013156:Splenectomy; D013159:Splenic Infarction / Q000209:etiology / Q000601:surgery; D006113:United Kingdom