Efficacy of the slow firing method using a reinforced triple-row stapler for preventing postoperative pancreatic fistula during laparoscopic distal pancreatectomy

• Published in: Surgery today (Tokyo, Japan) Vol. 52; no. 2; pp. 260 - 267
• Main Authors: Matsumoto, Ippei, Kamei, Keiko, Satoi, Shumpei, Murase, Takaaki, Matsumoto, Masataka, Kawaguchi, Kohei, Yoshida, Yuta, Dongha, Lee, Takebe, Atsushi, Nakai, Takuya, Takeyama, Yoshifumi
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.02.2022
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Female; Glycosides; Humans; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Original Article; Pancreatectomy - methods; Pancreatic Fistula - prevention & control; Postoperative Complications - prevention & control; Pregnanes; Risk Factors; Safety; Surgery; Surgical Oncology; Surgical Staplers; Surgical Stapling - instrumentation; Surgical Stapling - methods; Treatment Outcome; Young Adult; Reinforced stapler; Postoperative pancreatic fistula; Slow firing method; Laparoscopic distal pancreatectomy; Clinically relevant postoperative pancreatic fistula
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-021-02344-z

Purpose Postoperative pancreatic fistula (POPF) remains the most clinically relevant complication of laparoscopic distal pancreatectomy (LDP). The present study evaluated the efficacy of the “slow firing method” using a reinforced triple-row stapler (Covidien, Tokyo, Japan) during LDP. Methods This retrospective single-center study included 73 consecutive patients who underwent LDP using the slow firing method. A black cartridge was used in all patients. The primary endpoint was the rate of clinically relevant POPF (CR-POPF) after LDP. Secondary endpoints included perioperative outcomes and factors associated with CR-POPF as well as the correlation between the transection time and thickness of the pancreas. Results Four patients (5.5%) developed CR-POPF (grade B). Overall morbidity rates, defined as grade ≥ II and ≥ III according to the Clavien-Dindo classification, were 21 and 11%, respectively. The median postoperative hospital stay was 10 days. Preoperative diabetes (13.6 vs. 0.2%, P  = 0.044) and thickness of the pancreas ≥ 15 mm (13.8% vs. 0%, P  = 0.006) were identified as independent risk factors for CR-POPF. The median transection time was 16 (8–29) min. Conclusion The slow firing method using a reinforced triple-row stapler for pancreatic transection is simple, safe, and effective for preventing CR-POPF after LDP.