Nonclosure technique with saline-coupled bipolar electrocautery in management of the cut surface after distal pancreatectomy

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著者

    • KITAGAWA HIROHISA
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University
    • OHTA TETSUO
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University
    • TANI TAKASHI
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University
    • TAJIMA HIDEHIRO
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University
    • NAKAGAWARA HISATOSHI
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University
    • OHNISHI ICHIRO
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University
    • TAKAMURA HIROYUKI
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University
    • KAYAHARA MASATO
    • Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University

抄録

Background/Purpose: Management of the pancreatic remnant after distal pancreatectomy is still debated, the most serious complication is development of a pancreatic fistula. We developed a nonclosure technique with saline-coupled bipolar electrocautery for preventing fistula formation after distal pancreatectomy as an alternative to traditional stump closure methods. Methods: The distinguishing feature of this technique is nonclosure of the stump, relying instead upon dependable ligation of the main pancreatic duct and sealing of the cut surface by shrinkage accomplished by low-temperature coagulation using saline-coupled bipolar electrocautery. A recent addition has been intraoperative stenting of the remnant pancreatic duct. Results: To date we have used the nonclosure technique in 40 cases, among which 5 (12.5%) developed fistulas: 4 in the nonstenting subgroup (14.8%) and 1 in the stenting subgroup (7.7%). According to a recent classification, 4 fistulas were considered grade A; 1, grade B; and 0, grade C. The grade B patient did not undergo stenting. Conclusion: Our preliminary experience should prompt more widespread evaluation of the nonclosure technique. © Springer Japan 2008.

収録刊行物

  • Journal of hepato-biliary-pancreatic surgery  

    Journal of hepato-biliary-pancreatic surgery 15(4), 377-383, 2008-07-01 

    Springer Verlag

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