Aoki Takeshi, Mansour Doaa A, Koizumi Tomotake, Matsuda Kazuhiro, Kusano Tomokazu, Wada Yusuke, Hakozaki Tomoki, Tomioka Kodai, Hirai Takahito, Yamazaki Tatsuya, Watanabe Makoto, Otsuka Koji, Gahin Ahmed Elewa Abbas, Murakami Masahiko
Division of Gastroenterological and General Surgery, Department of Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 1428666, Japan.
General Surgery Department, Cairo University Hospitals, Kasr Alainy, Al-Saray street, El-Manial, Cairo, 11956, Egypt.
BMC Surg. 2020 Oct 6;20(1):223. doi: 10.1186/s12893-020-00876-8.
Pancreatic fistula is one of the serious complications for patients undergoing distal pancreatectomy, which leads to significant morbidity. The aim of our study is to compare linear stapling closure plus continuous suture with linear stapling closure alone during laparoscopic distal pancreatectomy (LDP) in terms of clinically relevant postoperative pancreatic fistula (POPF) rate.
Twenty-two patients underwent LDP at our institution between 2011 and 2013. Twelve patients had linear stapling closure with peri-firing compression (LSC) alone compared with ten patients who had linear stapling closure, peri-firing compression plus continuous suture (LSC/CS) for stump closure of remnant pancreas in LDP. Biochemical leak and clinically relevant POPF were compared between both groups.
POPF occurred in 4 of 12 (33.3%) patients with linear stapling closure while no patient developed a clinically relevant POPF in the triple combination of linear stapling, peri-firing compression plus continuous suture group (p = 0.043).1 patient (8.3%) in the LSC group and 5 patients (50%) in the LSC/CS group had evidence of a biochemical leak. There were no significant differences in operative time (188.3 vs 187.0 min) and blood loss (135 vs. 240 g) between both groups but there was a significantly of shorter length of hospital stay (11.9 vs. 19.9 days) in LSC/CS group (p = 0.037). There was no mortality in either group.
The triple combination of linear stapling, peri-firing compression plus continuous suture in LDP has effectively prevented occurrence of clinically relevant ISGPF POPF.
The study was retrospectively registered September 30, 2019 at Showa University Ethics Committee as IRB protocol numbers 2943.
胰瘘是接受胰体尾切除术患者的严重并发症之一，会导致显著的发病率。我们研究的目的是比较腹腔镜胰体尾切除术（LDP）中单纯线性吻合器闭合与线性吻合器闭合加连续缝合在临床相关术后胰瘘（POPF）发生率方面的差异。
2011年至2013年期间，22例患者在我院接受了LDP。12例患者仅采用带钉合时压迫的线性吻合器闭合（LSC），而10例患者在LDP中对残余胰腺残端采用线性吻合器闭合、带钉合时压迫加连续缝合（LSC/CS）。比较两组的生化漏和临床相关POPF情况。
12例接受线性吻合器闭合的患者中有4例（33.3%）发生POPF，而在采用线性吻合器、带钉合时压迫加连续缝合三联组合的组中无患者发生临床相关POPF（p = 0.043）。LSC组有1例患者（8.3%）出现生化漏，LSC/CS组有5例患者（50%）出现生化漏。两组手术时间（188.3对187.0分钟）和失血量（135对240克）无显著差异，但LSC/CS组住院时间显著缩短（11.9对19.9天）（p = 0.037）。两组均无死亡病例。
LDP中线性吻合器、带钉合时压迫加连续缝合的三联组合有效预防了临床相关的国际胰腺外科研究组（ISGPF）POPF的发生。
该研究于2019年9月30日在昭和大学伦理委员会进行回顾性注册，IRB协议编号为2943。
