Analysis of closure of the pancreatic remnant after distal pancreatic resection

Abstract

Distal pancreatectomy is a relevant procedure for chronic pancreatitis, other benign diseases, malignant diseases, cysts of the pancreas, and pancreatic parenchyma damage after abdominal trauma, with overall increasing frequency and decreasing mortality below 5% in high volume centers [ 1 x [1] Fahy, B.N., Frey, C.F., Ho, H.S., Beckett, L., and Bold, R.J. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg. 2002; 183: 237–241 Abstract | Full Text | Full Text PDF | PubMed | Scopus (183) | Google Scholar See all References , 2 x [2] Neoptolemos, J.P., Russell, R.C., Bramhall, S., and Theis, B. Low mortality following resection for pancreatic and periampullary tumours in 1026 patients: UK survey of specialist pancreatic units. UK Pancreatic Cancer Group. Br J Surg. 1997; 84: 1370–1376 Crossref | PubMed | Scopus (322) | Google Scholar See all References , 3 x [3] Balcom, J.H.T., Rattner, D.W., Warshaw, A.L., Chang, Y., and Fernandez-del Castillo, C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001; 136: 391–398 Crossref | PubMed | Google Scholar See all References ]. Despite the experience gained since the technique for distal pancreas resection was outlined by Mayo in 1913 [ 4 x [4] Mayo, W.J. The surgery of the pancreas. Ann Surg. 1913; 58: 145–150 Crossref | PubMed | Google Scholar See all References ] [4] , the management of the remaining pancreatic tissue is still a considerable clinical problem [ 5 x [5] Knaebel, H.P., Diener, M.K., Wente, M.N., Buchler, M.W., and Seiler, C.M. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2005; 92: 539–546 Crossref | PubMed | Scopus (242) | Google Scholar See all References , 6 x [6] Shrikhande, S.V., Qureshi, S.S., Rajneesh, N., and Shukla, P.J. Pancreatic anastomoses after pancreaticoduodenectomy: do we need further studies. World J Surg. 2005; 29: 1642–1649 Crossref | PubMed | Scopus (93) | Google Scholar See all References ]. In particular, pancreatic leak following distal pancreatic resection has been the foremost complication in terms of frequency and associated morbidity [ 7 x [7] Montorsi, M., Zago, M., Mosca, F., Capussotti, L., Zotti, E., and Ribotta, G. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery. 1995; 117: 26–31 Abstract | Full Text PDF | PubMed | Scopus (260) | Google Scholar See all References , 8 x [8] Fernandez-del Castillo, C., Rattner, D.W., and Warshaw, A.L. Standards for pancreatic resection in the 1990s. Arch Surg. 1995; 130: 295–299 Crossref | PubMed | Scopus (443) | Google Scholar See all References , 9 x [9] Ohwada, S., Ogawa, T., Tanahashi, Y., Nakamura, S., Takeyoshi, I., and Ohya, T. Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg. 1998; 22: 494–498 Crossref | PubMed | Scopus (115) | Google Scholar See all References ]. It is believed that patients with a non-dilated Wirsung's duct and a soft friable pancreatic gland are especially susceptible to this complication [ 10 x [10] Sato, N., Yamaguchi, K., Chijiiwa, K., and Tanaka, M. Risk analysis of pancreatic fistula after pancreatic head resection. Arch Surg. 1998; 133: 1094–1098 Crossref | PubMed | Scopus (144) | Google Scholar See all References , 11 x [11] Marcus, S.G., Cohen, H., and Ranson, J.H. Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Ann Surg. 1995; 221: 635–645 Crossref | PubMed | Scopus (205) | Google Scholar See all References , 12 x [12] Hamanaka, Y., Nishihara, K., Hamasaki, T., Kawabata, A., Yamamoto, S., and Tsurumi, M. Pancreatic juice output after pancreatoduodenectomy in relation to pancreatic consistency, duct size, and leakage. Surgery. 1996; 119: 281–287 Abstract | Full Text PDF | PubMed | Scopus (136) | Google Scholar See all References , 13 x [13] Suzuki, Y., Fujino, Y., Tanioka, Y., Hiraoka, K., Takada, M., and Ajiki, T. Selection of pancreaticojejunostomy techniques according to pancreatic texture and duct size. Arch Surg. 2002; 13: 1044–1047 Crossref | Scopus (72) | Google Scholar See all References ].