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Pancreatic fistula following laparoscopic distal pancreatectomy is probably unrelated to the stapler size but to the drainage modality and significantly decreased with a small suction drain

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Abstract

Introduction

Risk factors of postoperative pancreatic fistula (POPF) after laparoscopic distal pancreatectomy (LDP) are not well known and were studied, including the stapler cartridge size and drainage modality.

Methods

Between January 2008 and December 2016, 181 LDP were performed and the pancreas was sectioned by stapler in 130 patients (72%). Patients received white (2.5 mm), blue (3.5 mm), or green (4.1 mm) staplers and the size was not based on any pre or peroperative randomization. As primary analysis of the first 84 patients (28 in each group) showed no effect of stapler size on POPF, we decided to use the white (total = 47) or blue and finally the blue (total = 55) of medium size for standardization. Drainage was obtained by multi-tubular drain (first, 79) and a small suction drain (last, 102). Risk factors of POPF were studied and grades B and C were compared to grade A or no POPF.

Results

POPF (n = 66; 36%) was of grade A (n = 25, 14%), grade B (n = 32, 18%), and grade C (n = 9, 5%). The comparison of the three groups of staplers showed that the blue stapler was used more with a small suction drain (85 vs 23%, p < 0.0001), had lower rate of grade B POPF (p = 0.028), and a shorter hospital stay (p = 0.004). On multivariate analysis, only the use of a small suction drain was associated with significant decrease in grades B and C POPF (6 vs 44%, odds ratio 7.385 (1.919–28.418); p = 0.004).

Conclusion

The occurrence of POPF following LDP is influenced by the type of drainage alone and is significantly decreased with a small suction drain.

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Authors and Affiliations

  1. Department of HPB surgery and liver transplantation, Beaujon Hospital, APHP, University Paris VII, 100 boulevard du General Leclerc, 92110, Clichy, France

    Safi Dokmak, Fadhel Samir Ftériche, Roberto Luca Meniconi, Béatrice Aussilhou, Igor Duquesne, Genaro Perrone, Jacques Belghiti, Olivier Soubrane & Alain Sauvanet

  2. Department of Anesthesiology and Intensive care medicine, Military Hospital of Tunis, Tunis, Tunisia

    Chihebeddine Romdhani

  3. Department of Gastroenterology and Pancreatic Diseases, Beaujon Hospital, APHP, University Paris VII, Clichy, France

    Philippe Lévy

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  1. Safi Dokmak
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  4. Béatrice Aussilhou
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Correspondence to Safi Dokmak.

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Part of this study was presented as an oral communication at the Congress of French Association of Surgery (AFC), 28–30 September 2016, Paris, France.

A part of this study was presented as a poster at the IHPBA, Sao Paulo, Brazil, April 2015.

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Dokmak, S., Ftériche, F.S., Meniconi, R.L. et al. Pancreatic fistula following laparoscopic distal pancreatectomy is probably unrelated to the stapler size but to the drainage modality and significantly decreased with a small suction drain. Langenbecks Arch Surg 404, 203–212 (2019). https://doi.org/10.1007/s00423-019-01756-3

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