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Risk factor analysis and prevention of postoperative pancreatic fistula after distal pancreatectomy with stapler use
Author(s) -
Sugimoto Motokazu,
Gotohda Naoto,
Kato Yuichiro,
Takahashi Shinichiro,
Kinoshita Takahiro,
Shibasaki Hidehito,
Nomura Shogo,
Konishi Masaru,
Kaneko Hironori
Publication year - 2013
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-013-0596-0
Subject(s) - pancreatic fistula , medicine , incidence (geometry) , pancreas , risk factor , surgery , pancreatectomy , complication , body mass index , distal pancreatectomy , fistula , pancreaticoduodenectomy , gastroenterology , general surgery , physics , optics
Background Postoperative pancreatic fistula (POPF) is a major, intractable complication after distal pancreatectomy (DP). Risk factor evaluation and prevention of this complication are important tasks for pancreatic surgeons. Methods One hundred and six patients who underwent DP using a stapler for pancreatic division were retrospectively investigated. The relationship between clinicopathological factors and the incidence of POPF was statistically analyzed. Results Clinically relevant, Grade B or C POPF by International Study Group of Pancreatic Fistula criteria occurred in 52 patients (49.1 %). Age, American Society of Anesthesiologists score, body mass index, and concomitant gastrointestinal tract resection did not influence the incidence of POPF. Use of a double‐row stapler and a thick pancreatic stump were significant risk factors for POPF in multivariate analysis. Compression index was also shown to be an important factor in cases in which the pancreas was divided by a stapler. Conclusions The most important risk factor for POPF after DP was suggested to be the thickness of the pancreatic stump, reflecting the volume of remnant pancreas. A triple‐row stapler seemed to be superior to a double‐row stapler in preventing POPF. However, triple‐row stapler use in a thick pancreas is considered to be a future problem to be solved.