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Erschienen in: Surgery Today 6/2013

01.06.2013 | Review Article

The management of a remnant pancreatic stump for preventing the development of postoperative pancreatic fistulas after distal pancreatectomy: current evidence and our strategy

verfasst von: Isamu Makino, Hirohisa Kitagawa, Hisatoshi Nakagawara, Hidehiro Tajima, Itasu Ninomiya, Sachio Fushida, Takashi Fujimura, Tetsuo Ohta

Erschienen in: Surgery Today | Ausgabe 6/2013

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Abstract

Distal pancreatectomy (DP) is the most common surgical procedure for treating benign and malignant lesions in the body or tail of the pancreas. Although the mortality rate related to DP has recently been reduced, the postoperative morbidity remains high. The most frequent and dismal complication occurring after DP is the development of postoperative pancreatic fistulas (POPF). Several resection methods and closure techniques for treating remnant pancreas have been developed in an effort to reduce the incidence of complications, especially POPF. However, the optimal procedure has not yet been established. In this review, we summarize the current clinical data and evidence for surgical techniques and perioperative management strategies for preventing POPF after DP. Finally, we introduce our non-closure technique for managing remnant pancreatic stumps.
Literatur
1.
Zurück zum Zitat Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRef Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.PubMedCrossRef
2.
Zurück zum Zitat Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003;138:1310–4.PubMedCrossRef Buchler MW, Wagner M, Schmied BM, Uhl W, Friess H, Z’graggen K. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003;138:1310–4.PubMedCrossRef
3.
Zurück zum Zitat Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Colemanet J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430–5.PubMedCrossRef Cameron JL, Pitt HA, Yeo CJ, Lillemoe KD, Kaufman HS, Colemanet J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993;217:430–5.PubMedCrossRef
4.
Zurück zum Zitat Fernandez-del CC, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg. 1995;130:295–9.CrossRef Fernandez-del CC, Rattner DW, Warshaw AL. Standards for pancreatic resection in the 1990s. Arch Surg. 1995;130:295–9.CrossRef
5.
Zurück zum Zitat van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 2005;242:781–8 (discussion 788). van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 2005;242:781–8 (discussion 788).
6.
Zurück zum Zitat Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Ann Surg. 1995;221:721–31.PubMedCrossRef Yeo CJ, Cameron JL, Lillemoe KD, Sitzmann JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas: 201 patients. Ann Surg. 1995;221:721–31.PubMedCrossRef
7.
Zurück zum Zitat Neoptolemos JP, Russell RC, Bramhall S, 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;84:1370–6.PubMedCrossRef Neoptolemos JP, Russell RC, Bramhall S, 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;84:1370–6.PubMedCrossRef
8.
Zurück zum Zitat Reeh M, Nentwich MF, Bogoevski D, Koenig AM, Gebauer F, Tachezy M, et al. High surgical morbidity following distal pancreatectomy: still an unsolved problem. World J Surg. 2011;35:1110–7.PubMedCrossRef Reeh M, Nentwich MF, Bogoevski D, Koenig AM, Gebauer F, Tachezy M, et al. High surgical morbidity following distal pancreatectomy: still an unsolved problem. World J Surg. 2011;35:1110–7.PubMedCrossRef
9.
Zurück zum Zitat Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg. 2002;183:237–41.PubMedCrossRef Fahy BN, Frey CF, Ho HS, Beckett L, Bold RJ. Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg. 2002;183:237–41.PubMedCrossRef
10.
Zurück zum Zitat Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg. 2010;34:121–5.PubMedCrossRef Yoshioka R, Saiura A, Koga R, Seki M, Kishi Y, Morimura R, et al. Risk factors for clinical pancreatic fistula after distal pancreatectomy: analysis of consecutive 100 patients. World J Surg. 2010;34:121–5.PubMedCrossRef
11.
Zurück zum Zitat Kelly KJ, Greenblatt DY, Wan Y, Rettammel RJ, Winslow E, Cho CS, et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011;15:250–61.PubMedCrossRef Kelly KJ, Greenblatt DY, Wan Y, Rettammel RJ, Winslow E, Cho CS, et al. Risk stratification for distal pancreatectomy utilizing ACS-NSQIP: preoperative factors predict morbidity and mortality. J Gastrointest Surg. 2011;15:250–61.PubMedCrossRef
12.
Zurück zum Zitat Kleeff J, Diener MK, Z’graggen K, Hinz U, Wagner M, Bachmann J, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245:573–82.PubMedCrossRef Kleeff J, Diener MK, Z’graggen K, Hinz U, Wagner M, Bachmann J, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245:573–82.PubMedCrossRef
13.
Zurück zum Zitat Pannegeon V, Pessaux P, Sauvanet A, Vullierme MP, Kianmanesh R, Belghiti J. Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg. 2006;141(11):1071–6.PubMedCrossRef Pannegeon V, Pessaux P, Sauvanet A, Vullierme MP, Kianmanesh R, Belghiti J. Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg. 2006;141(11):1071–6.PubMedCrossRef
14.
Zurück zum Zitat Ziegler KM, Nakeeb A, Pitt HA, Schmidt CM, Bishop SN, Moreno J, et al. Pancreatic surgery: evolution at a high-volume center. Surgery. 2010;148:702–10.PubMedCrossRef Ziegler KM, Nakeeb A, Pitt HA, Schmidt CM, Bishop SN, Moreno J, et al. Pancreatic surgery: evolution at a high-volume center. Surgery. 2010;148:702–10.PubMedCrossRef
15.
Zurück zum Zitat Goh BK, Tan YM, Chung YF, Cheow PC, Ong HS, Chan WH, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg. 2008;143:956–65.PubMedCrossRef Goh BK, Tan YM, Chung YF, Cheow PC, Ong HS, Chan WH, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg. 2008;143:956–65.PubMedCrossRef
16.
Zurück zum Zitat Ridolfini MP, Alfieri S, Gourgiotis S, Di Miceli D, Rotondi F, Quero G, et al. Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial? World J Gastroenterol. 2007;13:5096–100.PubMed Ridolfini MP, Alfieri S, Gourgiotis S, Di Miceli D, Rotondi F, Quero G, et al. Risk factors associated with pancreatic fistula after distal pancreatectomy, which technique of pancreatic stump closure is more beneficial? World J Gastroenterol. 2007;13:5096–100.PubMed
17.
Zurück zum Zitat Balzano G, Zerbi A, Cristallo M, Di Carlo V. The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg. 2005;9:837–42.PubMedCrossRef Balzano G, Zerbi A, Cristallo M, Di Carlo V. The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg. 2005;9:837–42.PubMedCrossRef
18.
Zurück zum Zitat Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, et al. Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg. 2008;12:1691–7.PubMedCrossRef Ferrone CR, Warshaw AL, Rattner DW, Berger D, Zheng H, Rawal B, et al. Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg. 2008;12:1691–7.PubMedCrossRef
19.
Zurück zum Zitat Harris LJ, Abdollahi H, Newhook T, Sauter PK, Crawford AG, Chojnacki KA, et al. Optimal technical management of stump closure following distal pancreatectomy: a retrospective review of 215 cases. J Gastrointest Surg. 2010;14:998–1005.PubMedCrossRef Harris LJ, Abdollahi H, Newhook T, Sauter PK, Crawford AG, Chojnacki KA, et al. Optimal technical management of stump closure following distal pancreatectomy: a retrospective review of 215 cases. J Gastrointest Surg. 2010;14:998–1005.PubMedCrossRef
20.
Zurück zum Zitat Balzano G, Zerbi A, Cristallo M, Di Carlo V. The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg. 2005;9:837–42.PubMedCrossRef Balzano G, Zerbi A, Cristallo M, Di Carlo V. The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg. 2005;9:837–42.PubMedCrossRef
21.
Zurück zum Zitat Nagai S, Fujii T, Kodera Y, Kanda M, Sahin TT, Kanzaki A, et al. Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol. 2011;18:2329–37.PubMedCrossRef Nagai S, Fujii T, Kodera Y, Kanda M, Sahin TT, Kanzaki A, et al. Recurrence pattern and prognosis of pancreatic cancer after pancreatic fistula. Ann Surg Oncol. 2011;18:2329–37.PubMedCrossRef
22.
Zurück zum Zitat Bassi C, Butturini G, Molinari E, Mascetta G, Salvia R, Falconi M, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg. 2004;21:54–9.PubMedCrossRef Bassi C, Butturini G, Molinari E, Mascetta G, Salvia R, Falconi M, et al. Pancreatic fistula rate after pancreatic resection. The importance of definitions. Dig Surg. 2004;21:54–9.PubMedCrossRef
23.
Zurück zum Zitat Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13. Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.
24.
Zurück zum Zitat Bassi C, Butturini G, Falconi M, Salvia R, Sartori N, Caldiron E, et al. Prospective randomised pilot study of management of the pancreatic stump following distal resection. HPB. 1999;1:203–7. Bassi C, Butturini G, Falconi M, Salvia R, Sartori N, Caldiron E, et al. Prospective randomised pilot study of management of the pancreatic stump following distal resection. HPB. 1999;1:203–7.
25.
Zurück zum Zitat Knaebel HP, Diener MK, Wente MN, Büchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2005;92:539–46.PubMedCrossRef Knaebel HP, Diener MK, Wente MN, Büchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2005;92:539–46.PubMedCrossRef
26.
Zurück zum Zitat Zhou W, Lv R, Wang X, Mou Y, Cai X, Herr I. Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg. 2010;200:529–36.PubMedCrossRef Zhou W, Lv R, Wang X, Mou Y, Cai X, Herr I. Stapler vs suture closure of pancreatic remnant after distal pancreatectomy: a meta-analysis. Am J Surg. 2010;200:529–36.PubMedCrossRef
27.
Zurück zum Zitat Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet. 2011;377:1514–22.PubMedCrossRef Diener MK, Seiler CM, Rossion I, Kleeff J, Glanemann M, Butturini G, et al. Efficacy of stapler versus hand-sewn closure after distal pancreatectomy (DISPACT): a randomised, controlled multicentre trial. Lancet. 2011;377:1514–22.PubMedCrossRef
28.
Zurück zum Zitat Suzuki Y, Fujino Y, Tanioka Y, Hori Y, Ueda T, Takeyama Y, et al. Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg. 1999;86:608–11.PubMedCrossRef Suzuki Y, Fujino Y, Tanioka Y, Hori Y, Ueda T, Takeyama Y, et al. Randomized clinical trial of ultrasonic dissector or conventional division in distal pancreatectomy for non-fibrotic pancreas. Br J Surg. 1999;86:608–11.PubMedCrossRef
29.
Zurück zum Zitat Sugo H, Mikami Y, Matsumoto F, Tsumura H, Watanabe Y, Futagawa S. Comparison of ultrasonically activated scalpel versus conventional division for the pancreas in distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2001;8:349–52.PubMedCrossRef Sugo H, Mikami Y, Matsumoto F, Tsumura H, Watanabe Y, Futagawa S. Comparison of ultrasonically activated scalpel versus conventional division for the pancreas in distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2001;8:349–52.PubMedCrossRef
30.
Zurück zum Zitat Okabayashi T, Hanazaki K, Nishimori I, Sugimoto T, Yoshioka R, Dabanaka K, et al. Pancreatic transection using a sharp hook-shaped ultrasonically activated scalpel. Langenbecks Arch Surg. 2008;393:1005–8.PubMedCrossRef Okabayashi T, Hanazaki K, Nishimori I, Sugimoto T, Yoshioka R, Dabanaka K, et al. Pancreatic transection using a sharp hook-shaped ultrasonically activated scalpel. Langenbecks Arch Surg. 2008;393:1005–8.PubMedCrossRef
31.
Zurück zum Zitat Matsumoto T, Ishio T, Sasaki A, Aramaki M, Bandoh T, Kawano K, et al. Pancreatic resection with ultrasonically activated scalpel: preliminary observations. Hepatogastroenterology. 2002;49:635–8.PubMed Matsumoto T, Ishio T, Sasaki A, Aramaki M, Bandoh T, Kawano K, et al. Pancreatic resection with ultrasonically activated scalpel: preliminary observations. Hepatogastroenterology. 2002;49:635–8.PubMed
32.
Zurück zum Zitat Truty MJ, Sawyer MD, Que FG. Decreasing pancreatic leak after distal pancreatectomy: saline-coupled radiofrequency ablation in a porcine model. J Gastrointest Surg. 2007;11:998–1007.PubMedCrossRef Truty MJ, Sawyer MD, Que FG. Decreasing pancreatic leak after distal pancreatectomy: saline-coupled radiofrequency ablation in a porcine model. J Gastrointest Surg. 2007;11:998–1007.PubMedCrossRef
33.
Zurück zum Zitat Blansfield JA, Rapp MM, Chokshi RJ, Woll NL, Hunsinger MA, Sheldon DG, et al. Novel method of stump closure for distal pancreatectomy with a 75 % reduction in pancreatic fistula rate. J Gastrointest Surg. 2012;16:524–8. Blansfield JA, Rapp MM, Chokshi RJ, Woll NL, Hunsinger MA, Sheldon DG, et al. Novel method of stump closure for distal pancreatectomy with a 75 % reduction in pancreatic fistula rate. J Gastrointest Surg. 2012;16:524–8.
34.
Zurück zum Zitat Kawai M, Tani M, Yamaue H. Transection using bipolar scissors reduces pancreatic fistula after distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:366–72.PubMedCrossRef Kawai M, Tani M, Yamaue H. Transection using bipolar scissors reduces pancreatic fistula after distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:366–72.PubMedCrossRef
35.
Zurück zum Zitat Hartwig W, Duckheim M, Strobel O, Dovzhanskiy D, Bergmann F, Hackert T, et al. LigaSure for pancreatic sealing during distal pancreatectomy. World J Surg. 2010;34:1066–70.PubMedCrossRef Hartwig W, Duckheim M, Strobel O, Dovzhanskiy D, Bergmann F, Hackert T, et al. LigaSure for pancreatic sealing during distal pancreatectomy. World J Surg. 2010;34:1066–70.PubMedCrossRef
36.
Zurück zum Zitat Nagakawa Y, Tsuchida A, Saito H, Tohyama Y, Matsudo T, Kawakita H, et al. The VIO soft-coagulation system can prevent pancreatic fistula following pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:359–65.PubMedCrossRef Nagakawa Y, Tsuchida A, Saito H, Tohyama Y, Matsudo T, Kawakita H, et al. The VIO soft-coagulation system can prevent pancreatic fistula following pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:359–65.PubMedCrossRef
37.
Zurück zum Zitat Ikegami T, Maeda T, Kayashima H, Oki E, Yoshizumi T, Sakaguchi Y, et al. Soft coagulation, polyglycolic acid felt, and fibrin glue for prevention of pancreatic fistula after distal pancreatectomy. Surg Today. 2011;41:1224–7.PubMedCrossRef Ikegami T, Maeda T, Kayashima H, Oki E, Yoshizumi T, Sakaguchi Y, et al. Soft coagulation, polyglycolic acid felt, and fibrin glue for prevention of pancreatic fistula after distal pancreatectomy. Surg Today. 2011;41:1224–7.PubMedCrossRef
38.
Zurück zum Zitat Moriura S, Kimura A, Ikeda S, Iwatsuka Y, Ikezawa T, Naiki K. Closure of the distal pancreatic stump with a seromuscular flap. Surg Today. 1995;25:992–4.PubMedCrossRef Moriura S, Kimura A, Ikeda S, Iwatsuka Y, Ikezawa T, Naiki K. Closure of the distal pancreatic stump with a seromuscular flap. Surg Today. 1995;25:992–4.PubMedCrossRef
39.
Zurück zum Zitat Kluger Y, Alfici R, Abbley B, Soffer D, Aladgem D. Gastric serosal patch in distal pancreatectomy for injury: a neglected technique. Injury. 1997;28:127–9.PubMedCrossRef Kluger Y, Alfici R, Abbley B, Soffer D, Aladgem D. Gastric serosal patch in distal pancreatectomy for injury: a neglected technique. Injury. 1997;28:127–9.PubMedCrossRef
40.
Zurück zum Zitat Wagner M, Gloor B, Ambühl M, Worni M, Lutz JA, Angst E, et al. Roux-en-Y drainage of the pancreatic stump decreases pancreatic fistula after distal pancreatic resection. J Gastrointest Surg. 2007;11:303–8.PubMedCrossRef Wagner M, Gloor B, Ambühl M, Worni M, Lutz JA, Angst E, et al. Roux-en-Y drainage of the pancreatic stump decreases pancreatic fistula after distal pancreatic resection. J Gastrointest Surg. 2007;11:303–8.PubMedCrossRef
41.
Zurück zum Zitat Oláh A, Issekutz A, Belágyi T, Hajdú N, Romics L Jr. Randomized clinical trial of techniques for closure of the pancreatic remnant following distal pancreatectomy. Br J Surg. 2009;96:602–7.PubMedCrossRef Oláh A, Issekutz A, Belágyi T, Hajdú N, Romics L Jr. Randomized clinical trial of techniques for closure of the pancreatic remnant following distal pancreatectomy. Br J Surg. 2009;96:602–7.PubMedCrossRef
42.
Zurück zum Zitat Suzuki Y, Kuroda Y, Morita A, Fujino Y, Tanioka Y, Kawamura T, et al. Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Arch Surg. 1995;130:952–5.PubMedCrossRef Suzuki Y, Kuroda Y, Morita A, Fujino Y, Tanioka Y, Kawamura T, et al. Fibrin glue sealing for the prevention of pancreatic fistulas following distal pancreatectomy. Arch Surg. 1995;130:952–5.PubMedCrossRef
43.
Zurück zum Zitat Ohwada S, Ogawa T, Tanahashi Y, Nakamura S, Takeyoshi I, Ohya T, et al. Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg. 1998;22:494–8.PubMedCrossRef Ohwada S, Ogawa T, Tanahashi Y, Nakamura S, Takeyoshi I, Ohya T, et al. Fibrin glue sandwich prevents pancreatic fistula following distal pancreatectomy. World J Surg. 1998;22:494–8.PubMedCrossRef
44.
Zurück zum Zitat Velanovich V. The use of tissue sealant to prevent fistula formation after laparoscopic distal pancreatectomy. Surg Endosc. 2007;21:1222.PubMedCrossRef Velanovich V. The use of tissue sealant to prevent fistula formation after laparoscopic distal pancreatectomy. Surg Endosc. 2007;21:1222.PubMedCrossRef
45.
Zurück zum Zitat Mita K, Ito H, Fukumoto M, Murabayashi R, Koizumi K, Hayashi T, et al. A fibrin adhesive sealing method for the prevention of pancreatic fistula following distal pancreatectomy. Hepatogastroenterology. 2011;58:604–8.PubMed Mita K, Ito H, Fukumoto M, Murabayashi R, Koizumi K, Hayashi T, et al. A fibrin adhesive sealing method for the prevention of pancreatic fistula following distal pancreatectomy. Hepatogastroenterology. 2011;58:604–8.PubMed
46.
Zurück zum Zitat Yamamoto M, Hayashi MS, Nguyen NT, Nguyen TD, McCloud S, Imagawa DK. Use of Seamguard to prevent pancreatic leak following distal pancreatectomy. Arch Surg. 2009;144:894–9.PubMedCrossRef Yamamoto M, Hayashi MS, Nguyen NT, Nguyen TD, McCloud S, Imagawa DK. Use of Seamguard to prevent pancreatic leak following distal pancreatectomy. Arch Surg. 2009;144:894–9.PubMedCrossRef
47.
Zurück zum Zitat Thaker RI, Matthews BD, Linehan DC, Strasberg SM, Eagon JC, Hawkins WG. Absorbable mesh reinforcement of a stapled pancreatic transection line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg. 2007;11:59–65.PubMedCrossRef Thaker RI, Matthews BD, Linehan DC, Strasberg SM, Eagon JC, Hawkins WG. Absorbable mesh reinforcement of a stapled pancreatic transection line reduces the leak rate with distal pancreatectomy. J Gastrointest Surg. 2007;11:59–65.PubMedCrossRef
48.
Zurück zum Zitat Ochiai T, Sonoyama T, Soga K, Inoue K, Ikoma H, Shiozaki A, et al. Application of polyethylene glycolic acid felt with fibrin sealant to prevent postoperative pancreatic fistula in pancreatic surgery. J Gastrointest Surg. 2010;14:884–90.PubMedCrossRef Ochiai T, Sonoyama T, Soga K, Inoue K, Ikoma H, Shiozaki A, et al. Application of polyethylene glycolic acid felt with fibrin sealant to prevent postoperative pancreatic fistula in pancreatic surgery. J Gastrointest Surg. 2010;14:884–90.PubMedCrossRef
49.
Zurück zum Zitat Fingerhut A, Veyrie N, Ata T, Alexakis N, Leandros E. Use of sealants in pancreatic surgery: critical appraisal of the literature. Dig Surg. 2009;26:7–14.PubMedCrossRef Fingerhut A, Veyrie N, Ata T, Alexakis N, Leandros E. Use of sealants in pancreatic surgery: critical appraisal of the literature. Dig Surg. 2009;26:7–14.PubMedCrossRef
50.
Zurück zum Zitat D’Andrea AA, Costantino V, Sperti C, Pedrazzoli S. Human fibrin sealant in pancreatic surgery: it is useful in preventing fistulas? A prospective randomized study. Ital J Gastroenterol. 1994;26:283–6.PubMed D’Andrea AA, Costantino V, Sperti C, Pedrazzoli S. Human fibrin sealant in pancreatic surgery: it is useful in preventing fistulas? A prospective randomized study. Ital J Gastroenterol. 1994;26:283–6.PubMed
51.
Zurück zum Zitat Suc B, Msika S, Fingerhut A, Fourtanier G, Hay JM, Holmières F, The French Associations for Surgical Research, et al. Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection: prospective randomized trial. Ann Surg. 2003;237:57–65.PubMedCrossRef Suc B, Msika S, Fingerhut A, Fourtanier G, Hay JM, Holmières F, The French Associations for Surgical Research, et al. Temporary fibrin glue occlusion of the main pancreatic duct in the prevention of intra-abdominal complications after pancreatic resection: prospective randomized trial. Ann Surg. 2003;237:57–65.PubMedCrossRef
52.
Zurück zum Zitat Tashiro S, Murata E, Hiraoka T, Nakakuma K, Watanabe E, Miyauchi Y. New technique for pancreaticojejunostomy using a biological adhesive. Br J Surg. 1987;74:392–4.PubMedCrossRef Tashiro S, Murata E, Hiraoka T, Nakakuma K, Watanabe E, Miyauchi Y. New technique for pancreaticojejunostomy using a biological adhesive. Br J Surg. 1987;74:392–4.PubMedCrossRef
53.
Zurück zum Zitat Tran K, Van Eijck C, Di Carlo V, Hop WC, Zerbi A, Balzano G, et al. Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg. 2002;236:422–8.PubMedCrossRef Tran K, Van Eijck C, Di Carlo V, Hop WC, Zerbi A, Balzano G, et al. Occlusion of the pancreatic duct versus pancreaticojejunostomy: a prospective randomized trial. Ann Surg. 2002;236:422–8.PubMedCrossRef
54.
Zurück zum Zitat Lillemoe KD, Cameron JL, Kim MP, Campbell KA, Sauter PK, Coleman JA, et al. Does fibrin glue sealant decrease the rate of pancreatic fistula after pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg. 2004;8:766–74.PubMedCrossRef Lillemoe KD, Cameron JL, Kim MP, Campbell KA, Sauter PK, Coleman JA, et al. Does fibrin glue sealant decrease the rate of pancreatic fistula after pancreaticoduodenectomy? Results of a prospective randomized trial. J Gastrointest Surg. 2004;8:766–74.PubMedCrossRef
55.
Zurück zum Zitat Renou C, Grandval P, Ville E, Laugier R. Endoscopic treatment of the main pancreatic duct: correlations among morphology, manometry, and clinical follow-up. Int J Pancreatol. 2000;27:143–9.PubMedCrossRef Renou C, Grandval P, Ville E, Laugier R. Endoscopic treatment of the main pancreatic duct: correlations among morphology, manometry, and clinical follow-up. Int J Pancreatol. 2000;27:143–9.PubMedCrossRef
56.
Zurück zum Zitat Abe N, Sugiyama M, Suzuki Y, Yamaguchi Y, Yanagida O, Masaki T, et al. Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. Am J Surg. 2006;191:198–200.PubMedCrossRef Abe N, Sugiyama M, Suzuki Y, Yamaguchi Y, Yanagida O, Masaki T, et al. Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. Am J Surg. 2006;191:198–200.PubMedCrossRef
57.
Zurück zum Zitat Abe N, Sugiyama M, Suzuki Y, Yamaguchi T, Mori T, Atomi Y. Preoperative endoscopic pancreatic stenting: a novel prophylactic measure against pancreatic fistula after distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:373–6.PubMedCrossRef Abe N, Sugiyama M, Suzuki Y, Yamaguchi T, Mori T, Atomi Y. Preoperative endoscopic pancreatic stenting: a novel prophylactic measure against pancreatic fistula after distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:373–6.PubMedCrossRef
58.
Zurück zum Zitat Fischer CP, Bass B, Fahy B, Aloia T. Transampullary pancreatic duct stenting decreases pancreatic fistula rate following left pancreatectomy. Hepatogastroenterology. 2008;55:244–8.PubMed Fischer CP, Bass B, Fahy B, Aloia T. Transampullary pancreatic duct stenting decreases pancreatic fistula rate following left pancreatectomy. Hepatogastroenterology. 2008;55:244–8.PubMed
59.
Zurück zum Zitat Rieder B, Krampulz D, Adolf J, Pfeiffer A. Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy. Gastrointest Endosc. 2010;72:536–42.PubMedCrossRef Rieder B, Krampulz D, Adolf J, Pfeiffer A. Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy. Gastrointest Endosc. 2010;72:536–42.PubMedCrossRef
60.
Zurück zum Zitat Oida T, Mimatsu K, Kawasaki A, Kanou H, Kuboi Y, Kida K, Amano S. Transduodenal pancreatic juice drainage for preventing pancreatic fistula formation after distal pancreatectomy. Hepatogastroenterology. 2011;58:177–82.PubMed Oida T, Mimatsu K, Kawasaki A, Kanou H, Kuboi Y, Kida K, Amano S. Transduodenal pancreatic juice drainage for preventing pancreatic fistula formation after distal pancreatectomy. Hepatogastroenterology. 2011;58:177–82.PubMed
61.
Zurück zum Zitat Büchler M, Friess H, Klempa I, Hermanek P, Sulkowski U, Becker H, et al. Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg. 1992;163:125–30.PubMedCrossRef Büchler M, Friess H, Klempa I, Hermanek P, Sulkowski U, Becker H, et al. Role of octreotide in the prevention of postoperative complications following pancreatic resection. Am J Surg. 1992;163:125–30.PubMedCrossRef
62.
Zurück zum Zitat Lange JR, Steinberg SM, Doherty GM, Langstein HN, White DE, Shawker TH, et al. A randomized, prospective trial of postoperative somatostatin analogue in patients with neuroendocrine tumors of the pancreas. Surgery. 1992;112:1033–8.PubMed Lange JR, Steinberg SM, Doherty GM, Langstein HN, White DE, Shawker TH, et al. A randomized, prospective trial of postoperative somatostatin analogue in patients with neuroendocrine tumors of the pancreas. Surgery. 1992;112:1033–8.PubMed
63.
Zurück zum Zitat Pederzoli P, Bassi C, Falconi M, Camboni MG. Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Italian Study Group. Br J Surg. 1994;81:265–9.PubMedCrossRef Pederzoli P, Bassi C, Falconi M, Camboni MG. Efficacy of octreotide in the prevention of complications of elective pancreatic surgery. Italian Study Group. Br J Surg. 1994;81:265–9.PubMedCrossRef
64.
Zurück zum Zitat Friess H, Beger HG, Sulkowski U, Becker H, Hofbauer B, Dennler HJ, et al. Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis. Br J Surg. 1995;82:1270–3.PubMedCrossRef Friess H, Beger HG, Sulkowski U, Becker H, Hofbauer B, Dennler HJ, et al. Randomized controlled multicentre study of the prevention of complications by octreotide in patients undergoing surgery for chronic pancreatitis. Br J Surg. 1995;82:1270–3.PubMedCrossRef
65.
Zurück zum Zitat Montorsi M, Zago M, Mosca F, Capussotti L, Zotti E, Ribotta G, et al. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery. 1995;117:26–31.PubMedCrossRef Montorsi M, Zago M, Mosca F, Capussotti L, Zotti E, Ribotta G, et al. Efficacy of octreotide in the prevention of pancreatic fistula after elective pancreatic resections: a prospective, controlled, randomized clinical trial. Surgery. 1995;117:26–31.PubMedCrossRef
66.
Zurück zum Zitat Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg. 2000;232:419–29.PubMedCrossRef Yeo CJ, Cameron JL, Lillemoe KD, Sauter PK, Coleman J, Sohn TA, et al. Does prophylactic octreotide decrease the rates of pancreatic fistula and other complications after pancreaticoduodenectomy? Results of a prospective randomized placebo-controlled trial. Ann Surg. 2000;232:419–29.PubMedCrossRef
67.
Zurück zum Zitat Gouillat C, Chipponi J, Baulieux J, Partensky C, Saric J, Gayet B. Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy. Br J Surg. 2001;88:1456–62.PubMedCrossRef Gouillat C, Chipponi J, Baulieux J, Partensky C, Saric J, Gayet B. Randomized controlled multicentre trial of somatostatin infusion after pancreaticoduodenectomy. Br J Surg. 2001;88:1456–62.PubMedCrossRef
68.
Zurück zum Zitat Sarr MG. The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg. 2003;196:556–65.PubMedCrossRef Sarr MG. The potent somatostatin analogue vapreotide does not decrease pancreas-specific complications after elective pancreatectomy: a prospective, multicenter, double-blinded, randomized, placebo-controlled trial. J Am Coll Surg. 2003;196:556–65.PubMedCrossRef
69.
Zurück zum Zitat Suc B, Msika S, Piccinini M, Fourtanier G, Hay JM, Flamant Y, French Associations for Surgical Research, et al. Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial. Arch Surg. 2004;139:288–95.PubMedCrossRef Suc B, Msika S, Piccinini M, Fourtanier G, Hay JM, Flamant Y, French Associations for Surgical Research, et al. Octreotide in the prevention of intra-abdominal complications following elective pancreatic resection: a prospective, multicenter randomized controlled trial. Arch Surg. 2004;139:288–95.PubMedCrossRef
70.
Zurück zum Zitat Hesse UJ, DeDecker C, Houtmeyers P, Demetter P, Ceelen W, Pattyn P, et al. Prospectively randomized trial using perioperative low-dose octreotide to prevent organ-related and general complications after pancreatic surgery and pancreatico-jejunostomy. World J Surg. 2005;29:1325–8.PubMedCrossRef Hesse UJ, DeDecker C, Houtmeyers P, Demetter P, Ceelen W, Pattyn P, et al. Prospectively randomized trial using perioperative low-dose octreotide to prevent organ-related and general complications after pancreatic surgery and pancreatico-jejunostomy. World J Surg. 2005;29:1325–8.PubMedCrossRef
71.
Zurück zum Zitat Shan YS, Sy ED, Tsai ML, Tang LY, Li PS, Lin PW. Effects of somatostatin prophylaxis after pylorus-preserving pancreaticoduodenectomy: increased delayed gastric emptying and reduced plasma motilin. World J Surg. 2005;29:1319–24.PubMedCrossRef Shan YS, Sy ED, Tsai ML, Tang LY, Li PS, Lin PW. Effects of somatostatin prophylaxis after pylorus-preserving pancreaticoduodenectomy: increased delayed gastric emptying and reduced plasma motilin. World J Surg. 2005;29:1319–24.PubMedCrossRef
72.
Zurück zum Zitat Koti RS, Gurusamy KS, Fusai G, Davidson BR. Meta-analysis of randomized controlled trials on the effectiveness of somatostatin analogues for pancreatic surgery: a Cochrane review. HPB (Oxford). 2010;12:155–65.CrossRef Koti RS, Gurusamy KS, Fusai G, Davidson BR. Meta-analysis of randomized controlled trials on the effectiveness of somatostatin analogues for pancreatic surgery: a Cochrane review. HPB (Oxford). 2010;12:155–65.CrossRef
73.
Zurück zum Zitat Borja-Cacho D, Al-Refaie WB, Vickers SM, Tuttle TM, Jensen EH. Laparoscopic distal pancreatectomy. J Am Coll Surg. 2009;209:758–65.PubMedCrossRef Borja-Cacho D, Al-Refaie WB, Vickers SM, Tuttle TM, Jensen EH. Laparoscopic distal pancreatectomy. J Am Coll Surg. 2009;209:758–65.PubMedCrossRef
74.
Zurück zum Zitat Al-Taan OS, Stephenson JA, Briggs C, Pollard C, Metcalfe MS, Dennison AR. Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford). 2010;12:239–43. Al-Taan OS, Stephenson JA, Briggs C, Pollard C, Metcalfe MS, Dennison AR. Laparoscopic pancreatic surgery: a review of present results and future prospects. HPB (Oxford). 2010;12:239–43.
75.
Zurück zum Zitat Ammori BJ, Ayiomamitis GD. Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc. 2011;25:2084–99.PubMedCrossRef Ammori BJ, Ayiomamitis GD. Laparoscopic pancreaticoduodenectomy and distal pancreatectomy: a UK experience and a systematic review of the literature. Surg Endosc. 2011;25:2084–99.PubMedCrossRef
76.
Zurück zum Zitat Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248:438–46.PubMed Kooby DA, Gillespie T, Bentrem D, Nakeeb A, Schmidt MC, Merchant NB, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248:438–46.PubMed
77.
Zurück zum Zitat Velanovich V. Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg. 2006;10:95–8.PubMedCrossRef Velanovich V. Case-control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg. 2006;10:95–8.PubMedCrossRef
78.
Zurück zum Zitat Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc. 2008;22:1334–8.PubMedCrossRef Eom BW, Jang JY, Lee SE, Han HS, Yoon YS, Kim SW. Clinical outcomes compared between laparoscopic and open distal pancreatectomy. Surg Endosc. 2008;22:1334–8.PubMedCrossRef
79.
Zurück zum Zitat Mehta SS, Doumane G, Mura T, Nocca D, Fabre JM. Laparoscopic versus open distal pancreatectomy: a single-institution case–control study. Surg Endosc. 2012;26:402–7.PubMedCrossRef Mehta SS, Doumane G, Mura T, Nocca D, Fabre JM. Laparoscopic versus open distal pancreatectomy: a single-institution case–control study. Surg Endosc. 2012;26:402–7.PubMedCrossRef
80.
Zurück zum Zitat Nakamura Y, Uchida E, Aimoto T, Matsumoto S, Yoshida H, Tajiri T. Clinical outcome of laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2009;16:35–41.PubMedCrossRef Nakamura Y, Uchida E, Aimoto T, Matsumoto S, Yoshida H, Tajiri T. Clinical outcome of laparoscopic distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2009;16:35–41.PubMedCrossRef
81.
Zurück zum Zitat Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, et al. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg. 2010;145:616–21.PubMedCrossRef Vijan SS, Ahmed KA, Harmsen WS, Que FG, Reid-Lombardo KM, Nagorney DM, et al. Laparoscopic vs open distal pancreatectomy: a single-institution comparative study. Arch Surg. 2010;145:616–21.PubMedCrossRef
82.
Zurück zum Zitat Abu Hilal M, Hamdan M, Di Fabio F, Pearce NW, Johnson CD. Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg Endosc. 2012;26:1670–4. Abu Hilal M, Hamdan M, Di Fabio F, Pearce NW, Johnson CD. Laparoscopic versus open distal pancreatectomy: a clinical and cost-effectiveness study. Surg Endosc. 2012;26:1670–4.
83.
Zurück zum Zitat Matsumoto T, Shibata K, Ohta M, Iwaki K, Uchida H, Yada K, et al. Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech. 2008;18:340–3.PubMedCrossRef Matsumoto T, Shibata K, Ohta M, Iwaki K, Uchida H, Yada K, et al. Laparoscopic distal pancreatectomy and open distal pancreatectomy: a nonrandomized comparative study. Surg Laparosc Endosc Percutan Tech. 2008;18:340–3.PubMedCrossRef
84.
Zurück zum Zitat Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg. 2010;210:779–87.PubMedCrossRef Kooby DA, Hawkins WG, Schmidt CM, Weber SM, Bentrem DJ, Gillespie TW, et al. A multicenter analysis of distal pancreatectomy for adenocarcinoma: is laparoscopic resection appropriate? J Am Coll Surg. 2010;210:779–87.PubMedCrossRef
85.
Zurück zum Zitat DiNorcia J, Schrope BA, Lee MK, Reavey PL, Rosen SJ, Lee JA, et al. Laparoscopic distal pancreatectomy offers shorter hospital stays with fewer complications. J Gastrointest Surg. 2010;14:1804–12.PubMedCrossRef DiNorcia J, Schrope BA, Lee MK, Reavey PL, Rosen SJ, Lee JA, et al. Laparoscopic distal pancreatectomy offers shorter hospital stays with fewer complications. J Gastrointest Surg. 2010;14:1804–12.PubMedCrossRef
86.
Zurück zum Zitat Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, et al. Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc. 2008;22:2261–8.PubMedCrossRef Kim SC, Park KT, Hwang JW, Shin HC, Lee SS, Seo DW, et al. Comparative analysis of clinical outcomes for laparoscopic distal pancreatic resection and open distal pancreatic resection at a single institution. Surg Endosc. 2008;22:2261–8.PubMedCrossRef
87.
Zurück zum Zitat Kitagawa H, Ohta T, Tani T, Tajima H, Nakagawara H, Ohnishi I, et al. Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:377–83.PubMedCrossRef Kitagawa H, Ohta T, Tani T, Tajima H, Nakagawara H, Ohnishi I, et al. Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy. J Hepatobiliary Pancreat Surg. 2008;15:377–83.PubMedCrossRef
Metadaten
Titel
The management of a remnant pancreatic stump for preventing the development of postoperative pancreatic fistulas after distal pancreatectomy: current evidence and our strategy
verfasst von
Isamu Makino
Hirohisa Kitagawa
Hisatoshi Nakagawara
Hidehiro Tajima
Itasu Ninomiya
Sachio Fushida
Takashi Fujimura
Tetsuo Ohta
Publikationsdatum
01.06.2013
Verlag
Springer Japan
Erschienen in
Surgery Today / Ausgabe 6/2013
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-012-0370-y

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