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Complete REtraction of the StomaCh using pEnrose draiN and liver reTractor (CRESCENT) during laparoscopic distal pancreatectomy

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Abstract

Purpose

Laparoscopic distal pancreatectomy (LDP) is a well-accepted procedure for benign and malignant diseases of the pancreatic body and/or tail. To perform it safely, a wide operative field is crucial. For the maintenance of a good surgical field during LDP, we developed an original technique for stomach retraction: “Complete REtraction of the StomaCh using pEnrose draiN and liver reTractor, CRESCENT.”

Methods

In CRESCENT technique, the body and antrum of the stomach are suspended by two Penrose drains, and the fundus and/or upper body of the stomach are retracted upward using a liver retractor. After complete retraction, the stomach is well attached to the abdominal wall and forms a crescent-like shape. Before we developed the CRESCENT technique, we pulled the antrum of the stomach laterally by suture and hanged the body of the stomach upward using a Penrose drain (control method). We evaluated perioperative outcomes of the 87 consecutive patients who underwent LDP and compared outcomes of CRESCENT technique (n = 24) and previously used technique as a control (n = 63).

Results

Operative time was significantly shorter in the CRESCENT technique than in control method (median, 234 vs. 303 min, P < 0.001). We found no significant differences in incidences of overall morbidity (16.7 vs. 20.6%, P = 0.677), including grade B/C postoperative pancreatic fistula (8.3 vs. 7.9%, P = 0.455), between CRESCENT technique and control method. There was no mortality by either method.

Conclusions

Our original technique, CRESCENT, is a simple procedure in which the stomach is completely retracted during LDP.

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Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Seiko Hirono, Keiji Hayata, Manabu Kawai, Ken-ichi Okada, Motoki Miyazawa, Yuji Kitahata, Ryohei Kobayashi, Shinya Hayami, Masaki Ueno & Hiroki Yamaue

Authors
  1. Seiko Hirono
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  2. Keiji Hayata
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  3. Manabu Kawai
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Contributions

Hirono had full access to all data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Hirono, Hayata, Yamaue. Acquisition of data: Hirono, Hayata, Kawai, Okada, Ueno, Yamaue. Analysis and interpretation of data: Hirono, Kawai, Okada, Miyazawa, Ueno. Drafting of manuscript: Hirono, Hayata, Yamaue. Critical revision of manuscript: Hirono, Hayata, Yamaue. Administrative, technical, or material support: Hirono, Hayata, Kawai, Okada, Miyazawa, Kitahata, Kobayashi, Hayami, Ueno, Yamaue.

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Correspondence to Seiko Hirono.

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The authors declare that they have no conflicts of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The present retrospective study was approved by the Institutional Review Board of the Wakayama Medical University Hospital, with a waiver of the written informed consent from all patients concerned.

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Hirono, S., Hayata, K., Kawai, M. et al. Complete REtraction of the StomaCh using pEnrose draiN and liver reTractor (CRESCENT) during laparoscopic distal pancreatectomy. Langenbecks Arch Surg 405, 1243–1250 (2020). https://doi.org/10.1007/s00423-020-01929-5

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