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Laparoscopic Distal Pancreatectomy With Peritoneal Staple-line Reinforcement

A Novel Technique (With Video)

Bruno, Marco A. MD; Mandojana, Facundo MD; Liaño, Jilián MD; Doniquian, Alejandro M. MD; Alvarez, Fernando A. MD

Surgical Laparoscopy Endoscopy & Percutaneous Techniques: October 2019 - Volume 29 - Issue 5 - p e65–e68
doi: 10.1097/SLE.0000000000000698
Online Articles: Technical Reports
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Introduction: Postoperative pancreatic fistula (PPF) is still the major source of morbidity in distal pancreatectomy (DP). Despite the many surgical techniques and technology devices developed for the closure of the pancreatic stump, the PPF rate remains high, and there is no consensus with regard to the most appropriate stump closure technique. We herein present, for the first time, an innovative approach for staple-line reinforcement in DP using an autologous peritoneal patch.

Materials and Methods: The results of 2 consecutive patients who underwent laparoscopic DP due to mucinous cystic neoplasms were included in this report. The pancreas was transected with a reinforced stapler using a peritoneal patch obtained from the anterolateral wall of the abdomen, divided into 2 pieces, and sutured around each stapler jaw. The embedded video (Supplemental Digital Content 1, http://links.lww.com/SLE/A209) reports our standardized technique.

Results: Both patients had a favorable recovery without PPF or any complication and were discharged fully recovered 4 and 5 days after surgery without drains. Currently, both patients are alive and free of disease 1 year and 8 months after the procedure.

Conclusions: The use of an autologous parietal peritoneal patch for staple-line reinforcement in DP was feasible and safe in experienced hands. Further studies are needed to confirm our findings and elucidate whether this readily available, inexpensive, rapid, and versatile alternative could reduce the PPF rate.

Hepato-Pancreato-Biliary Surgery Section, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Argentina

The authors declares no conflicts of interest.

Reprints: Fernando A. Alvarez, MD, Hepato-Pancreato-Biliary Surgery Section, General Surgery Service, Clínica Universitaria Reina Fabiola, Universidad Católica de Córdoba, Oncativo 1248, Córdoba X5004FHP, Argentina (e-mail: fernandoalvarez@curf.ucc.edu.ar).

Received April 14, 2019

Accepted June 6, 2019

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