Junju Maehara, MD, Koji Asai, Manabu Watanabe, Hiroshi Matsukiyo, Tomoaki Saito, Tomotaka Ishii, Ryohei Watanabe, Toshiyuki Enomoto, Natsuya Katada, Yoshihisa Saida, Shinya Kusachi. Department of Surgery, Toho University Ohashi Medical Center
Introduction: We analyzed short-term outcome of laparoscopic distal pancreatectomy (LDP), and also reported on the management of the pancreatic stump.
Patients and methods: We introduced LDP in 2011, and 10 cases were included in this study. Pancreatic resection was performed using laparoscopic linear stapler. For every case, we used a black or green cartridge for more than 10 min. A polyglycolic acid (PGA) sheet with fibrin glue was wrapped around the pancreatic stump to prevent the occurrence of a postoperative pancreatic fistula (POPF).
Result: A total of 10 patients (2 male and 8 female; age range, 10–76 years; median age, 67 years) underwent LDP. Their final diagnoses were as followed; pancreatic neuroendocrine tumor (three cases), pancreatic ductal adenocarcinoma (two cases), intraductal papillary mucinous neoplasm, mucinous cystic neoplasm, solid pseudopapillary neoplasm, serous cystic neoplasm, and chronic pancreatitis. Spleen preserving LDP was performed in one case; the remaining patients underwent conventional LDP. The operative time was 401 (range, 210–600) min, and the estimated blood loss was 66 (0–2200) g. POPF occurred in three cases, including two cases of grade A and one case of grade B; thus, one case (10%) of clinical POPF (grade B and C) was observed. The other cases did not develop any postoperative complications > IIIa of the Clavien-Dindo classification.
Conclusion: We reported the results of short-term outcome after LDP, and the management of the pancreatic stump. Appropriate pancreatic resection with wrapping of a PGA sheet using fibrin glue may reduce the occurrence of POPF.