Premium
Nonclosure technique with saline‐coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy
Author(s) -
Kitagawa Hirohisa,
Ohta Tetsuo,
Tani Takashi,
Tajima Hidehiro,
Nakagawara Hisatoshi,
Ohnishi Ichiro,
Takamura Hiroyuki,
Kayahara Masato
Publication year - 2008
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-008-1332-z
Subject(s) - medicine , fistula , pancreatic fistula , anastomosis , pancreatic duct , surgery , general surgery , radiology , pancreas , pancreatitis
Background/Purpose Management of the pancreatic remnant after distal pancreatectomy is still debated, the most serious complication is development of a pancreatic fistula. We developed a nonclosure technique with saline‐coupled bipolar electrocautery for preventing fistula formation after distal pancreatectomy as an alternative to traditional stump closure methods. Methods The distinguishing feature of this technique is nonclosure of the stump, relying instead upon dependable ligation of the main pancreatic duct and sealing of the cut surface by shrinkage accomplished by low‐temperature coagulation using saline‐coupled bipolar electrocautery. A recent addition has been intraoperative stenting of the remnant pancreatic duct. Results To date we have used the nonclosure technique in 40 cases, among which 5 (12.5%) developed fistulas: 4 in the nonstenting subgroup (14.8%) and 1 in the stenting subgroup (7.7%). According to a recent classification, 4 fistulas were considered grade A; 1, grade B; and 0, grade C. The grade B patient did not undergo stenting. Conclusion Our preliminary experience should prompt more widespread evaluation of the nonclosure technique.