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Novel intraoperative use of the “Tensipresser” to assess factors predictive of pancreatic fistula after pancreaticoduodenectomy

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Abstract

Purposes

Pancreatic fistula (PF) is a challenging complication of pancreaticoduodenectomy (PD). ‘Soft pancreas’ is reported as a risk factor for PF; however, palpation by the surgeon is not an objective method of evaluating pancreatic texture. We conducted this study to investigate whether a texture analyzer called a “Tensipresser” can be used to quantify pancreatic tissue hardness and predict the development of postoperative PF.

Methods

We assessed pancreatic texture in 85 patients who underwent PD. After surgeons assessed the texture of the pancreas subjectively, the physical properties were measured on the pancreatic margin intraoperatively, by the two-bite method using the “Tensipresser”. The incidence and severity of PF were based on the definitions of the International Study Group on Pancreatic Fistula.

Results

Symptomatic PF (grade B and C) developed in 16% of the patients. Patients were divided into two groups based on the Tensipresser measurement: those with a soft and fragile pancreas with hardness < 2070 gw/cm2 and cohesiveness < 0.65 (SF group); and all other patients (non-SF group). In the univariate and multivariate analysis, a small pancreatic duct diameter (<4 mm), no conduction of preoperative chemoradiation therapy, and inclusion in the SF group were significant predictors of PF.

Conclusion

The Tensipresser can evaluate pancreatic texture objectively, helping to define intraoperatively, those at risk of the development of PF.

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Authors and Affiliations

  1. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Nakamichi 1-3-3, Higashinari-ku, Osaka, 537-0025, Japan

    Manabu Mikamori, Kunihito Gotoh, Hidenori Takahashi, Hirofumi Akita, Akira Tomokuni, Shogo Kobayashi, Masayuki Ohue, Yoshiyuki Fujiwara, Masahiko Yano, Osamu Ishikawa & Masato Sakon

  2. Department of Gastroenterological Surgery, Graduate School of Medicine Osaka University, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan

    Manabu Mikamori & Kunihito Gotoh

Authors
  1. Manabu Mikamori
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  2. Kunihito Gotoh
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  3. Hidenori Takahashi
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  4. Hirofumi Akita
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Correspondence to Kunihito Gotoh.

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Mikamori, M., Gotoh, K., Takahashi, H. et al. Novel intraoperative use of the “Tensipresser” to assess factors predictive of pancreatic fistula after pancreaticoduodenectomy. Surg Today 47, 1201–1207 (2017). https://doi.org/10.1007/s00595-017-1509-7

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  • DOI: https://doi.org/10.1007/s00595-017-1509-7

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