Langenbeck's Archives of Surgery

, Volume 398, Issue 8, pp 1083–1089 | Cite as

Continuous irrigation around pancreatic remnant decreases pancreatic fistula-related intraabdominal complications after distal pancreatectomy

Original Article

Abstract

Purpose

To evaluate whether the technique of irrigation around pancreatic remnant after distal pancreatectomy (DP) can reduce the incidence of postoperative pancreatic fistula (PF) and its related intraabdominal complications.

Methods

In the retrospective clinical trial, the technique of irrigation around pancreatic remnant after DP was introduced. The clinical data of 60 patients who underwent the irrigation technique (irrigation group) and the other 65 patients who did not undergo the technique (non-irrigation group) were recorded, respectively. Preoperative clinicopathological features, intraoperative parameters, postoperative morbidity, clinically significant PF, and its related intraabdominal complications were compared between the two groups.

Results

The patency of irrigation tubes and drains was maintained in 59 patients. The overall incidence of PF was 31.2 %. There was no significant difference in the rate of PF between the two groups (P = 0.781), but the rate of PF-related intraabdominal complications was significantly lower in the irrigation group than that in the non-irrigation group (5 vs. 18, P = 0.005). The overall incidence of intraabdominal complications was significantly lower in the irrigation group than that in the non-irrigation group (23 vs. 39, P = 0.025).

Conclusion

The technique of irrigation around pancreatic remnant after DP is a simple method for prevention of clinically significant PF and its related intraabdominal complications.

Keywords

Distal pancreatectomy Pancreatic fistula Complication Irrigation 

Notes

Conflicts of interest

None.

References

  1. 1.
    Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. Ann Surg 229:693–698PubMedCrossRefGoogle Scholar
  2. 2.
    Fahy BN, Frey CF, Ho HS, Ho HS, Beckett L, Bold RJ (2002) Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 183:237–241PubMedCrossRefGoogle Scholar
  3. 3.
    Pannegeon V, Pessaux P, Sauvanet A, Marie-Pierre V, Reza K, Jacques B (2006) Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg 141:1071–1076PubMedCrossRefGoogle Scholar
  4. 4.
    Kleeff J, Diener MK, Z'graggen K, Hinz U, Wagner M, Bachmann J, Zehetner J, Müller MW, Friess H, Büchler MW (2007) Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 245:573–582PubMedCrossRefGoogle Scholar
  5. 5.
    Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, Rodriguez R, Thayer SP, Fernandez-del Castillo C (2008) Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg 12(10):1691–1697PubMedCrossRefGoogle Scholar
  6. 6.
    Olah A, Issekutz A, Belayi T, Hajdu N, Jr LR (2009) Randomized clinical trial of techniques for closure of the pancreatic remnant following distal pancreatectomy. Br J Surg 96:602–607PubMedCrossRefGoogle Scholar
  7. 7.
    Seeliger H, Christians S, Angele MK, Kleespies A, Eichhorn ME, Ischenko I, Boeck S, Heinemann V, Jauch KW, Bruns CJ (2010) Risk factors for surgical complications in distal pancreatectomy. Am J Surg 200(3):311–317PubMedCrossRefGoogle Scholar
  8. 8.
    Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, Yamamoto J, Yamaguchi T (2010) Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg 34(1):121–125PubMedCrossRefGoogle Scholar
  9. 9.
    Nathan H, Cameron JL, Goodwin CR, Seth AK, Edil BH, Wolfgang CL, Pawlik TM, Schulick RD, Choti MA (2009) Risk factor for pancreatic leak after distal pancreatectomy. Ann Surg 250:277–281PubMedCrossRefGoogle Scholar
  10. 10.
    Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM (2005) Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 92:539–546PubMedCrossRefGoogle Scholar
  11. 11.
    Rodríguez JR, Germes SS, Pandharipande PV, Gazelle GS, Thayer SP, Warshaw AL, Fernández-del Castillo C (2006) Implications and cost of pancreatic leak following distal pancreatic resection. Arch Surg 141:361–365PubMedCrossRefGoogle Scholar
  12. 12.
    Beger HG, Buchler M, Bittner R, Block S, Nevalainen T, Roscher R (1988) Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg 75:207–212PubMedCrossRefGoogle Scholar
  13. 13.
    Farkas G, Marton J, Mandi Y, Zederkenyi S (1996) Surgical strategy and management of infected pancreatic necrosis. Br J Surg 83:930–933PubMedCrossRefGoogle Scholar
  14. 14.
    Dong X, Gao SL, Xie QP, Xu L, Xu YL, Wu YL (2008) In situ high-volume modified continuous closed and/or open lavage for infected necrotizing pancreatitis. Pancreas 36:44–49PubMedCrossRefGoogle Scholar
  15. 15.
    Nakano H, Asakura T, Sakurai J, Koizumi S, Asano T, Watanabe T, Otsubo T (2008) Prophylactic irrigation around a pancreaticojejunostomy for the treatment of a pancreatic fistula after a pancreaticoduodenectomy in patients with a risky pancreatic remnant. Hepatogastroenterology 55(82–83):717–721PubMedGoogle Scholar
  16. 16.
    Sawada S, Yamagishi F, Suzuki S, Matsuoha J, Arai H, Tsukada K (2008) Continuous irrigation with suction started at early days after pancreatic surgery prevents severe complications. Hepatogastroenterology 55(82–83):725–728PubMedGoogle Scholar
  17. 17.
    Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13PubMedCrossRefGoogle Scholar
  18. 18.
    Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW (2007) Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768PubMedCrossRefGoogle Scholar
  19. 19.
    Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Yeo CJ, Büchler MW (2007) Postpancreatectomy hemorrhage (PPH)—an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25PubMedCrossRefGoogle Scholar
  20. 20.
    Takeuchi K, Tsuzuki Y, Ando T, Sekihara M, Hara T, Kori T, Nakajima H, Kuwano H (2003) Distal pancreatectomy: is staple closure beneficial? ANZ J Surg 73:922–925PubMedCrossRefGoogle Scholar
  21. 21.
    Farkas G, Leindler L, Farkas GJR (2005) Safe closure technique for distal pancreatic resection. Langenbecks Arch Surg 390:29–31PubMedCrossRefGoogle Scholar
  22. 22.
    Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW (2003) Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg 90:190–196PubMedCrossRefGoogle Scholar
  23. 23.
    Suzuki Y, Fujino Y, Tanioka Y, Hori Y, Ueda T, Takeyama Y et al (1999) Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg 86:608–611PubMedCrossRefGoogle Scholar
  24. 24.
    Okabayashi T, Kobayashi M, Sugimoto T, Namikawa T, Okamoto K, Hokimoto N, Araki K (2004) Postoperative pancreatic fistula following distal pancreatectomy for pancreatic neoplasm; can pancreatic fistula be prevented? Hepatogastroenterology 51:1838–1841PubMedGoogle Scholar
  25. 25.
    Wagner M, Gloor B, Ambühl M, Worni M, Lutz JA, Angst E, Candinas D (2007) Roux-en-Y drainage of the pancreatic stump decreases pancreatic fistula after distal pancreatic resection. J Gastrointest Surg 11:303–308PubMedCrossRefGoogle Scholar
  26. 26.
    Sudo T, Murakami Y, Uemura K, Hayashidani Y, Hashimoto Y, Nakashima A, Ohge H, Sueda T (2011) Distal pancreatectomy with duct-to-mucosa pancreaticogastrostomy: a novel technique for preventing postoperative pancreatic fistula. Am J Surg 202:77–81PubMedCrossRefGoogle Scholar
  27. 27.
    Ohwada S, Ogawa T, Tanahashi Y, Nakamura S, Takeyoshi I, Ohya T, Ikeya T, Kawashima K, Kawashima Y, Morishita Y (1998) Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg 22:494–498PubMedCrossRefGoogle Scholar
  28. 28.
    Velanovich V (2007) The use of tissue sealant to prevent fistula formation after laparoscopic distal pancreatectomy. Surg Endosc 21:1222PubMedCrossRefGoogle Scholar
  29. 29.
    Thaker RI, Matthews BD, Linehan DC, Strasberg SM, Eagon JC, Hawkons WG (2007) Absorbable mesh reinforcement or a stapled pancreatic transaction line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg 11:59–65PubMedCrossRefGoogle Scholar
  30. 30.
    Walters DM, Stokes JB, Adams RB, Bauer TW (2011) Use of a falciform ligament pedicle flap to decrease pancreatic fistula after distal pancreatectomy. Pancreas 20:595–599CrossRefGoogle Scholar
  31. 31.
    Kuroki T, Tajima Y, Tsuneoka N, Adachi T, Kanematsu T (2009) Gastric wall-covering method prevents pancreatic fistula after distal pancreatectomy. Hepatogastroenterology 56:877–880PubMedGoogle Scholar
  32. 32.
    Moriura S, Kimura A, Ikeda S, Iwatsuka Y, Ikezawa T, Naiki K (1995) Closure of the distal pancreatic stump with a seromuscular flap. Surg Today 25:992–994PubMedCrossRefGoogle Scholar
  33. 33.
    Diener MK, Seiler CM, Inga R, Jörg K, Matthias G, Giovanni B, Ales T, Bruns CJ, Busch ORC, Stefan F, Orlin B, Neoptolemos JP, Christopher H, Tobias K, Marco N, Klaus G, Helmut W, Otto K, Peter L, Ulrich S, Jens N, Frederik B, Silke G, Heiss MM, Luntz S e P, Thomas B, Meinhard K, Büchler MW (2011) Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlledmulticentre trial. Lancet 377:1514–1522PubMedCrossRefGoogle Scholar
  34. 34.
    Balzano G, Zerbi A, Cristallo M, Carlo VD (2005) The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg 9:837–842PubMedCrossRefGoogle Scholar
  35. 35.
    Yasushi H, William Traverso L (2012) After distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure. J Gastrointest Surg 16:993–1003CrossRefGoogle Scholar
  36. 36.
    Conlon KC, Labow D, Leung D, Smith A, Jarnagin W, Coit DG, Merchant N, Brennan MF (2001) Prospective randomized clinical trial of the value of intraperitoneal drainage after pancreatic resection. Ann Surg 234:487–493PubMedCrossRefGoogle Scholar
  37. 37.
    Rau B, Bothe A, Beger HG (2005) Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery 138:28–39PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of General Surgery, Shengjing HospitalChina Medical UniversityShenyangChina

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