2010 Annual Meeting Abstracts
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Further Experience With Pancreatic Stump Closure Using a Reinforced Staple Line
*Georgios V. Georgakis1, *David Eisenberg2, Robert J. Piorkowski2, William P. Macaulay2, Ramon E Jimenez2
1University of Connecticut Medical School, Farmington, CT;2Hartford Hospital, Hartford, CT
Objective: Our group has previously demonstrated that pancreatic transection with a reinforced staple line results in significantly lower fistula rates than when stapling without reinforcement. (J Gastrointest Surg 2007, 11: 345-349). Main criticism of this initial study focused on the small size of the treated group (N=13). We now report 4 more years of experience with this technique with a larger sample size.
Design: Before-after trial. The experimental group consists of a consecutive series of stapled distal pancreatectomies with reinforcement performed by 3 surgical oncologists from 2005 to 2010. The control group is a consecutive series of stapled pancreatectomies without reinforcement performed between 2003 and 2005 (previously published).
Setting: Community teaching hospital.
Patients: Distal pancreatectomies with stapled pancreatic stump closure.
Intervention: Staple line reinforcement was done with Seamguard (W.L. Gore).
Main outcome measures: Pancreatic leak (fistulas and fluid collections), hospital length of stay, interventions required for fistula management.
Results: Forty-nine patients were included: 31 in the experimental group and 18 in the control group. Mean age was 62, 49% were males. Four operations were done laparoscopically. The most common diagnoses included adenocarcinoma (31%), cystic neoplasms (24%), and neuroendocrine tumors (20%). There were no operative mortalities. Postoperative pancreatic leak rate was 39% in the control group, and 4% in the experimental group (p<0.008). Six of 9 patients with leak required additional drain placement. Development of pancreatic leak resulted in prolonged hospital stays (12 vs 8 days, P < 0.02).
Conclusion: We demonstrate sustained success of reinforced staples for pancreatic stump closure. Our technique is easy and results in reduced morbidity and cost. Our results suggest that surgical drains may not be needed when using this technique.
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