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Efficacy of the slow firing method using a reinforced triple-row stapler for preventing postoperative pancreatic fistula during laparoscopic distal pancreatectomy

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Abstract

Purpose

Postoperative pancreatic fistula (POPF) remains the most clinically relevant complication of laparoscopic distal pancreatectomy (LDP). The present study evaluated the efficacy of the “slow firing method” using a reinforced triple-row stapler (Covidien, Tokyo, Japan) during LDP.

Methods

This retrospective single-center study included 73 consecutive patients who underwent LDP using the slow firing method. A black cartridge was used in all patients. The primary endpoint was the rate of clinically relevant POPF (CR-POPF) after LDP. Secondary endpoints included perioperative outcomes and factors associated with CR-POPF as well as the correlation between the transection time and thickness of the pancreas.

Results

Four patients (5.5%) developed CR-POPF (grade B). Overall morbidity rates, defined as grade ≥ II and ≥ III according to the Clavien-Dindo classification, were 21 and 11%, respectively. The median postoperative hospital stay was 10 days. Preoperative diabetes (13.6 vs. 0.2%, P = 0.044) and thickness of the pancreas ≥ 15 mm (13.8% vs. 0%, P = 0.006) were identified as independent risk factors for CR-POPF. The median transection time was 16 (8–29) min.

Conclusion

The slow firing method using a reinforced triple-row stapler for pancreatic transection is simple, safe, and effective for preventing CR-POPF after LDP.

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Abbreviations

CR-POPF:

Clinically relevant postoperative pancreatic fistula

DP::

Distal pancreatectomy

ISGPF::

International study group on pancreatic fistula

LDP:

Laparoscopic distal pancreatectomy

POPF:

Postoperative pancreatic fistula

PDAC:

Pancreatic ductal adenocarcinoma

PGA:

Polyglycolic acid

POD:

Postoperative day

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Funding

No grant support was provided for this study.

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Authors and Affiliations

  1. Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan

    Ippei Matsumoto, Keiko Kamei, Shumpei Satoi, Takaaki Murase, Masataka Matsumoto, Kohei Kawaguchi, Yuta Yoshida, Lee Dongha, Atsushi Takebe, Takuya Nakai & Yoshifumi Takeyama

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  1. Ippei Matsumoto
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  2. Keiko Kamei
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  3. Shumpei Satoi
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  4. Takaaki Murase
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  5. Masataka Matsumoto
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  6. Kohei Kawaguchi
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  7. Yuta Yoshida
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  11. Yoshifumi Takeyama
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Correspondence to Ippei Matsumoto.

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Matsumoto, I., Kamei, K., Satoi, S. et al. Efficacy of the slow firing method using a reinforced triple-row stapler for preventing postoperative pancreatic fistula during laparoscopic distal pancreatectomy. Surg Today 52, 260–267 (2022). https://doi.org/10.1007/s00595-021-02344-z

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  • DOI: https://doi.org/10.1007/s00595-021-02344-z

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