THE DEPENDENCE OF DIRECT RESULTS OF DISTAL PANCREATECTOMIES ON DIFFERENT PANCREATIC STUMP CLOSURE TECHNIQUES

The  OBJECTIVE  is  to  study  the  effect  of application of different  pancreatic stump  closure techniques to  the  postoperative period,  the frequency and  severity  of postoperative complications including postoperative pancreatic fistulas  after distal pancreatectomies. MATERIAL AND METHODS.  The  clinical  material  consisted of 126  patients who  underwent distal  pancreatectomies  (isolated or  in  combination  with  surgical   interventions  on  the  adjacent organs of  the  abdominal cavity  and retroperitoneal space).  The  patients  were   divided  into  4  groups  depending  on  the  pancreatic  stump   closure  techniques (isolated suturing  of the  main  pancreatic duct  of the  pancreatic stump  with its omentization by gastrocolic omentum or local sealing its  by  hemostatic sponge  (control  group);  using  a  local  biological  glue  2-octylcyanoacrylate; using  the  Endoscopic Linear  Cutter  Echelon; external transduodenal  transnasal  drainage of the  enlarged main  pancreatic duct  of the  pancreatic stump). We  evaluated the  influence   of  different  pancreatic stump   closure techniques  after  distal  pancreatectomies on  the postoperative period  as well the  frequency and  severity  of postoperative pancreatic fistulas  depending on the  diameter of the main  pancreatic duct  of pancreatic stump.   RESULTS.  The  overall  rate  of postoperative  complications in the  control  group of patients was  45.8  %, and  was  due  to an  increase in the  frequency of specific  complications (35.4  %). The  most  frequent complication  in  the  control  group   of  patients  was   postoperative  pancreatic  fistulas   –  29.2   %.  The  statistically   significant decrease  of  frequency  and   severity   of  postoperative  complications,  frequency  and   severity   of  postoperative  pancreatic fistulas and decrease of postoperative hospital-stay after the application of the proposed different pancreatic stump closure techniques were  revealed in comparison with the  control  group  of patients. There  was  no  hospital  mortality.  CONCLUSION. Distal  pancreatectomy with  «standard»  pancreatic stump   closure techniques  accompanied by  high  frequency and  severity of postoperative complications, as well as postoperative pancreatic fistulas. The use of the proposed pancreatic stump closure techniques after  distal  pancreatectomy led  to  a  decrease of  the  frequency and  severity   of  postoperative  complications, a decrease of the  frequency and  severity  of postoperative pancreatic fistulas,  and  a decrease of the  postoperative hospital-stay.

1. Ejaz A., Sachs T., He J. et al. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the Nationwide Inpatient Sample // Surgery. 2014. № 156. Р. 538–547. Doi: 10.1016/j.surg.2014.03.046.

2. Laparoscopic pancreatic resection – a review / V. Justin, A. Fingerhut, I. Khatkov, S. Uranues // Transl. Gastroenterol. Hepatol.2016. № 1. Р. 36. Doi: 10.21037/tgh.2016.04.02.

3. Mehrabi A., Hafezi M., Arvin J. et al. A systematic review and meta-analysis of laparoscopic versus open distal pancreatectomy for benign and malignant lesions of the pancreas : it’s time to randomize // Surgery. 2015. № 157 (1). Р. 45–55. Doi: 10.1016/j.surg.2014.06.081.

4. Uranues S., Alimoglu O., Todoric B. et al. Laparoscopic resection of the pancreatic tail with splenic preservation // Am. J. Surg. 2006. № 192 (2). Р. 257–261.

5. Goh B. K., Tan Y. M., Chung Y. F. et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula : a 21-year experience at a single institution // Arch. Surg. 2008. № 143 (10). Р. 956–965. Doi: 10.1001/archsurg.143.10.956.

6. Voskanyan S. E., Korsakov I. N., Naidenov E. V. Profilaktika ostrogo posleoperatsionnogo pankreatita v khirurgii raka podzheludochnoi zhelezy // Annaly khirurgicheskoi gepatologii. 2013. № 18 (2). Р. 95–102.

7. Voskanyan S. E., Zabelin M. V., Naidenov E. V. i dr. Rezul’taty kompleksnoi profilaktiki ostrogo posleoperatsionnogo pankreatita posle pryamykh operatsii na podzheludochnoi zhelezy // Annaly khirurgii. 2015. № 6. Р. 14–19.

8. Kriger A. G., Kubyshkin V. A., Karmazanovskii G. G. i dr. Posleoperatsionnyi pankreatit pri khirurgicheskikh vmeshatel’stvakh na podzheludochnoi zheleze // Khirurgiya. 2012. № 4. Р. 14–19.

9. Vychuzhanin D. V., Egorov A. V., Levkin V. V. i dr. Diagnostika i profilaktika posleoperatsionnogo pankreatita // Khirurgiya. 2012. № 4. Р. 63–69].

10. Voskanyan S. E., Korot’ko G. F. Morfofunktsional’naya organizatsiya podzheludochnoi zhelezy i ostryi posleoperatsionnyi pankreatit (eksperimental’nye i klinicheskie aspekty). M.: Litterra, 2017. 528 р.

11. Pankreatoduodenal’naya rezektsiya (аspekty khirurgicheskoi tekhniki, funktsional’nye posledstviya / V. I. Onopriev, G. F. Korot’ko, M. L. Rogal’, S. E. Voskanyan). Krasnodar, 2005. 135 p.

12. Akhtanin E. A., Kriger A. G. Prichiny vozniknoveniya i profilaktika pankreaticheskikh svishchei posle rezektsionnykh operatsii na podzheludochnoi zheleze // Khirurgiya. 2014. № 5. Р. 79–83.

13. Lermite E., Sommacale D., Piardi T. et al. Complications after pancreatic resection : diagnosis, prevention and management // Clin. Res. Hepatol. Gastroenterol. 2013. № 37 (3). Р. 230–239. Doi: 10.1016/j.clinre.2013.01.003.

14. Kriger A. G., Berelavichus S. V., Smirnov A. V. et al. Sravnitel’nye rezul’taty otkrytoi robot-assisirovannoi i laparoskopicheskoi distal’noi rezektsii podzheludochnoi zhelezy // Khirurgiya: Zhurnal imeni N. I. Pirogova. 2015. № 1. Р. 23–29. Doi: 10.17116/hirurgia2015123-29.

15. Duran H., Ielpo B., Caruso R. et al. Does robotic distal pancreatectomy surgery offer similar results as laparoscopic and open approach? A comparative study from a single medical center // Int. J. Med. Robot. 2014. № 10 (3). Р. 280–285. Doi: 10.1002/rcs.1569.

16. Conventional laparoscopic and robotassisted spleen-preserving pancreatectomy : does da Vinci have clinical advantages? / C. M. Kang, D. H. Kim, W. J. Lee, H. S. Chi // Surg. Endosc. 2011. № 25 (6). Р. 2004–2009. Doi: 10.1007/s00464-010-1504-1.

17. Dindo D., Demartines N., Clavien P. A. Classification of surgicalcomplications : a new proposal with evaluation in a cohort of 6336 patients and results of a survey // Ann. Surg. 2004. № 240 (2). Р. 205–213.

18. Bassi C., Marchegiani G., Dervenis C. et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula : 11 Years After // Surgery. 2017. № 161 (3). Р. 584–591. Doi: 10.1016/j.surg.2016.11.014.

19. Pulvirenti A., Ramera M., Bassi C. Modifications in the International Study Group for Pancreatic Surgery (ISGPS) definition of postoperative pancreatic fistula // Transl. Gastroenterol. Hepatol.2017. № 2. Р. 107. Doi: 10.21037/tgh.2017.11.14.