Use of Seamguard to prevent pancreatic leak following distal pancreatectomy.

OBJECTIVE: To investigate the use of Seamguard, a bioabsorbable staple line-reinforcement product, to prevent pancreatic leak after distal pancreatectomy. DESIGN, SETTING, AND PARTICIPANTS: A retrospective study examined 85 consecutive patients undergoing distal pancreatectomy at an academic institution from September 5, 1997, to September 30, 2007. MAIN OUTCOME MEASURES: Pancreatic fistula and overall mortality and morbidity. RESULTS: In February 2004, the use of Seamguard in distal pancreas resections was introduced at our institution. Indications for resection included trauma (11 patients), neoplasms (62 patients), and chronic pancreatitis (12 patients). Pancreatic leak was defined as drain output of 25 mL/d or more 7 days postoperatively with a drain amylase level of 1000 U/L or more. Pancreatic leak occurred in 10 of 38 patients (26%) undergoing conventional resection with suture ligation of the pancreatic duct or nonreinforced stapled resection vs 2 of 47 patients (4%) undergoing staple resection using Seamguard reinforcement. Multivariate analysis showed that use of Seamguard with the stapler independently decreased the risk for pancreatic fistula after distal pancreatectomy (odds ratio, 0.07; 95% confidence interval, 0.01-0.43; P = .01). CONCLUSIONS: The use of Seamguard is quickly becoming a common adjunct in distal pancreas resections. Our study shows a lower incidence of pancreatic leak after distal pancreatectomy with the use of this staple line-reinforcing product.

Laparoscopic distal pancreatic resection.

Laparoscopic resection is not an established treatment for pancreatic tumors. Previous reports, mainly in Europe and Japan, have demonstrated the potential utility of laparoscopic distal pancreatectomy (LDP). However, few reports have been published from the United States. We instituted a pilot program to assess LDP. A total of 11 patients were included from December 2003 to December 2004. All patients were staged with preoperative endoscopic ultrasound and received vaccinations for possible splenectomy. The indications for surgery were as follows: neuroendocrine tumor (n = 7), unspecified tumor (n = 1), and cystic neoplasm (n = 3). All procedures began with diagnostic laparoscopy and intraoperative ultrasound. Three patients underwent laparoscopic enucleation of a discrete pancreatic nodule. In eight patients, LDP was attempted. One patient required conversion to an open procedure. In the other seven patients, the procedure was completed laparoscopically, two with hand-assist. The average operative time was 5 hours and 3 minutes; average length of stay was 5 days; and the splenectomy rate was 57 per cent (n = 4). There was one complication of an infected hematoma. There were no pancreatic leaks, deaths, nor readmissions. LDP with or without splenectomy is feasible and can be performed with minimum morbidity and only slightly increased operative time.