title: Modified Hand-Sewn Closure With Retroperitoneal Tissue-covering Method Prevents Pancreatic Fistula in Laparoscopic Distal Pancreatectomy.
abstract: BACKGROUND
  In laparoscopic distal pancreatectomy, the stapler transection of the pancreas remains the preferred method; however, pancreatic fistula continues to be a critical unsolved problem. The aim of this study was to compare complications associated with distal pancreatectomy, especially regarding the formation of pancreatic fistula, with particular attention to the stapler and hand-sewn closure technique.
  
  
  METHODS
  Between January 2004 and June 2012, 47 patients underwent laparoscopic distal pancreatectomy. These patient's pancreatic bodies were similar, and they were subjected to closure of the pancreatic stump either by stapler (Staple group, n=21) or by a modified hand-sewn technique (Sewn group, n=26), and were subsequently retrospectively reviewed.
  
  
  RESULTS
  The incidence of PF was significantly higher in the "Staple group" compared with the "Sewn group." Likewise, the amylase levels in the drainage fluid, were significantly higher in the "Staple group" compared with the "Sewn group." Patients in the Sewn group had shorter median hospital stay compared with those in the Sewn group (5 vs. 8 d, P<0.001).
  
  
  CONCLUSIONS
  The 2-layer hand-sewn technique is a simple method, and it significantly decreased the incidence of PF and hospital stay compared with the use of staples in laparoscopy.
authors: *The Hainan Hospital & Chinese PLA General Hospital, Beijing †Department of General Surgery Fuzhou General Hospital, Fuzhou, China.
authors: Wenbin
authors: W
authors: Ji
authors: Youlong
authors: Y
authors: Wang
authors: Lie
authors: L
authors: Wang
authors: Huamin
authors: H
authors: Tan
authors: Jingwang
authors: J
authors: Tan
mesh_terms: D000328:Adult; D000681:Amylases / Q000378:metabolism; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D004322:Drainage; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010185:Pancreatic Fistula / Q000517:prevention & control*; D011183:Postoperative Complications / Q000517:prevention & control*; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods; D013536:Suture Techniques; D058106:Wound Closure Techniques
chemical_list: D000681:Amylases