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Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy

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Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Background/Purpose

Management of the pancreatic remnant after distal pancreatectomy is still debated, the most serious complication is development of a pancreatic fistula. We developed a nonclosure technique with saline-coupled bipolar electrocautery for preventing fistula formation after distal pancreatectomy as an alternative to traditional stump closure methods.

Methods

The distinguishing feature of this technique is nonclosure of the stump, relying instead upon dependable ligation of the main pancreatic duct and sealing of the cut surface by shrinkage accomplished by low-temperature coagulation using saline-coupled bipolar electrocautery. A recent addition has been intraoperative stenting of the remnant pancreatic duct.

Results

To date we have used the nonclosure technique in 40 cases, among which 5 (12.5%) developed fistulas: 4 in the nonstenting subgroup (14.8%) and 1 in the stenting subgroup (7.7%). According to a recent classification, 4 fistulas were considered grade A; 1, grade B; and 0, grade C. The grade B patient did not undergo stenting.

Conclusion

Our preliminary experience should prompt more widespread evaluation of the nonclosure technique.

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Authors and Affiliations

  1. Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan

    Hirohisa Kitagawa, Tetsuo Ohta, Takashi Tani, Hidehiro Tajima, Hisatoshi Nakagawara, Ichiro Ohnishi, Hiroyuki Takamura & Masato Kayahara

Authors
  1. Hirohisa Kitagawa
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  2. Tetsuo Ohta
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  3. Takashi Tani
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  4. Hidehiro Tajima
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  5. Hisatoshi Nakagawara
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  6. Ichiro Ohnishi
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  7. Hiroyuki Takamura
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  8. Masato Kayahara
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Kitagawa, H., Ohta, T., Tani, T. et al. Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy. J Hepatobiliary Pancreat Surg 15, 377–383 (2008). https://doi.org/10.1007/s00534-008-1332-z

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  • DOI: https://doi.org/10.1007/s00534-008-1332-z

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