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Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue

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Abstract

Purpose

Pancreatic fistula (PF) remains an obstacle to safe distal pancreatectomy (DP). A thick pancreatic parenchyma is a major risk factor for PF. In this paper, we elucidate the feasibility of the new closure method using soft coagulation and polyglycolic acid felt with fibrin glue.

Methods

In 2009–2013, 96 patients underwent DP with a novel closure method for pancreatic stump that utilized soft coagulation and polyglycolic acid felt with fibrin glue. We evaluated amylase levels in drainage fluid on postoperative days (POD) 1 and 3 and the incidence of postoperative PF according to International Study Group of Pancreatic Fistula (ISGPF) definitions.

Results

Drain amylase levels on POD1 and POD3 were 275 and 241 U/L, respectively, and ISGPF-defined Grade B/C PF rates were 16.7 %. No clinical factors were significantly associated with PF. Average pancreatic parenchymal thicknesses were similar in PF-positive and PF-negative patients (10.4 ± 2.6 mm vs. 10.1 ± 2.2 mm, P = 0.639). There was no significant difference in the postoperative PF rate between patients with thick (≥12 mm) and thin (<12 mm) pancreas (11.1 vs. 18.8 %, P = 0.544).

Conclusion

Our novel pancreatic stump closure method appears to be simple and effective, particularly in patients with thick pancreas.

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Conflicts of interest

None.

Author contribution

Akita H: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript

Takahashi H, Sakon M, and Ishikawa O: critical revision of manuscript

Gotoh K, Kobayashi S, and Yano M: acquisition of data

Sugimura K, Miyoshi N, Noura S, and Oue M: acquisition of data, analysis and interpretation of data

Fujiwara Y and Motoori M: analysis and interpretation of data

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Authors and Affiliations

  1. Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka City, Osaka, 537-8511, Japan

    Hirofumi Akita, Hidenori Takahashi, Kunihito Gotoh, Shogo Kobayashi, Keijiro Sugimura, Norikatsu Miyoshi, Masaaki Motoori, Shingo Noura, Yoshiyuki Fujiwara, Masayuki Oue, Masahiko Yano, Masato Sakon & Osamu Ishikawa

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  1. Hirofumi Akita
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  2. Hidenori Takahashi
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  3. Kunihito Gotoh
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Correspondence to Hirofumi Akita.

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Akita, H., Takahashi, H., Gotoh, K. et al. Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue. Langenbecks Arch Surg 400, 843–848 (2015). https://doi.org/10.1007/s00423-015-1339-2

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  • DOI: https://doi.org/10.1007/s00423-015-1339-2

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