Closure method for thick pancreas stump after distal pancreatectomy: soft coagulation and polyglycolic acid felt with fibrin glue.

Akita, Hirofumi; Takahashi, Hidenori; Gotoh, Kunihito; Kobayashi, Shogo; Sugimura, Keijiro; Miyoshi, Norikatsu; Motoori, Masaaki; Noura, Shingo; Fujiwara, Yoshiyuki; Oue, Masayuki; Yano, Masahiko; Sakon, Masato; Ishikawa, Osamu

PURPOSE Pancreatic fistula (PF) remains an obstacle to safe distal pancreatectomy (DP). A thick pancreatic parenchyma is a major risk factor for PF. In this paper, we elucidate the feasibility of the new closure method using soft coagulation and polyglycolic acid felt with fibrin glue. METHODS In 2009-2013, 96 patients underwent DP with a novel closure method for pancreatic stump that utilized soft coagulation and polyglycolic acid felt with fibrin glue. We evaluated amylase levels in drainage fluid on postoperative days (POD) 1 and 3 and the incidence of postoperative PF according to International Study Group of Pancreatic Fistula (ISGPF) definitions. RESULTS Drain amylase levels on POD1 and POD3 were 275 and 241 U/L, respectively, and ISGPF-defined Grade B/C PF rates were 16.7%. No clinical factors were significantly associated with PF. Average pancreatic parenchymal thicknesses were similar in PF-positive and PF-negative patients (10.4 ± 2.6 mm vs. 10.1 ± 2.2 mm, P = 0.639). There was no significant difference in the postoperative PF rate between patients with thick (≥12 mm) and thin (<12 mm) pancreas (11.1 vs. 18.8%, P = 0.544). CONCLUSION Our novel pancreatic stump closure method appears to be simple and effective, particularly in patients with thick pancreas.