Cadaveric Study of Pancreatic Duct Leak after Distal Pancreatectomy with Laparoscopic Stapler Based on Critical Findings in Clinical Study at Dalin Tzu Chi General Hospital = Cadaveric Study of Pancreatic Duct Leak after Distal Pancreatectomy with Laparoscopic Stapler Based on Critical Findings in Clinical Study at Dalin Tzu Chi General Hospital

다국어 초록 (Multilingual Abstract)

Aims: Our clinical study showed that transection site (body) and staple sizes (>2.5mm) were key factors contributing to the occurrence of postoperative pancreatic fistua( POPF). If we can create a neck (thin pancreas) on the body of the pancreas by slowly compressing before cutting using another clamp (double clamping) to allow optimal situation for 2.5mm staples, then the occurrence of POPF and leakage can be significantly reduced. Such a study is the first study in literature done on a well preserved cadaver
Methods: Three adult cadavers were used, with each pancreas exposed for convenience but with equipment of laparoscopy to showcase assure that the technique can be done laparoscopically. Each pancreas was cut at multiple sites: one cut at each neck and tail, and three cuts each on the body of the pancreas. Each cut different staple size ( 2.5 mm and 3.8 mm) and the clamping method (single or double). The leakage was checked by three steps: gross observation, probing with catheter, and methylene blue.
Results: Cuts performed with 2.5 mm staple and/or double clamping showed no leakage on both neck and body region. Cuts with both 3.8mm staple and single clamping technique show leakage on body region but no leakage at the neck and tail.
Conclusions: The result had supported the hypothesis of double clamping method and smaller staple can reduce the chance of leakage and therefore reduce the chance of fistula after the operation.