J Surg Tech Proced | Volume 9, Issue 1 | Research Article | Open Access
Hideki Sasanuma*, Yasunaru Sakuma, Kentaro Shimodaira, Yuki Kimura, Yuichi Aoki, Masanobu Taguchi, Yoshiyuki Meguro, Naoya Kasahara, Kazue Morishima, Atsushi Miki, Atsushi Yoshida, Kazuhiro Endo, Masaru Koizumi and Naohiro Sata
Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
*Correspondance to: Hideki Sasanuma
Fulltext PDFIntroduction: The incidence of postoperative pancreatic fistula (POPF) after laparoscopic distal pancreatectomy (Lap-DP) remains high. Peri-firing compression (PFC) has been reported to reduce POPF, but techniques have not been standardized. Methods: From March 2016 to January 2023, 53 consecutive patients (female = 27) with various types of pancreatic neoplasms underwent Lap-DP. All transactions were performed using electrically-powered staplers with a black cartridge. The standardized PFC techniques consisted of three steps: 10min of pre-compression, 5min of cutting, and 5min of post-compression (total cutting time = 20 min). Drain amylase (D-AMY) levels were measured on postoperative days 1, 3, 5, and 7 to evaluate POPF according to the 2016 International Study Group in Pancreatic Surgery (ISGPS) definition update. Postoperative complications were evaluated using the Clavien-Dindo (CD) classification. Preoperative computed tomography (CT) measured preoperative pancreatic thickness at the resection line. Results: POPF exhibited no biochemical leakage (BL) in 51 patients and grade B in 2 patients. No major complications beyond CD grade IIIb were observed. The mean pancreatic thickness of the stump was 15.4 mm. All patients were discharged approximately 13 days after surgery. Two patients with POPF(B) were characterised by a significantly higher D-AMY of 1POD, more than 30,000 U/ ml. Conclusions: The novel standardized 20-minute PFC techniques using an electrically powered stapler with a black cartridge during Lap-DP may safely and low incidence of POPF in patients with a soft pancreas thickness of up to 29.1 mm. Significantly higher D-AMY in 1POD is characteristic of patients with POPF(B).
Postoperative pancreatic fistula, Distal pancreatectomy, Stapling techniques, Perifiring compression
Sasanuma H, Sakuma Y, Shimodaira K, Kimura Y, Aoki Y, Taguchi M, et al. Standardized Pancreatic Transection in Laparoscopic Distal Pancreatectomy: A Novel Approach to Minimize Postoperative Pancreatic Fistula. J Surg Tech Proced. 2025; 9(1): 1076..