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Improved perioperative outcomes of laparoscopic distal pancreatosplenectomy: modified lasso technique.

Authors
  • Kawasaki, Yota1
  • Hwang, Ho Kyoung2, 3
  • Kang, Chang Moo2, 3
  • Natsugoe, Shoji1
  • Lee, Woo Jung2, 3
  • 1 Department of Digestive Surgery, Breast, and Thyroid Surgery, Graduate School of Medical Sciences, Kagoshima University, Kagoshima, Japan. , (Japan)
  • 2 Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea. , (North Korea)
  • 3 Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Severance Hospital, Seoul, South Korea. , (North Korea)
Type
Published Article
Journal
ANZ Journal of Surgery
Publisher
Wiley (Blackwell Publishing)
Publication Date
Sep 01, 2018
Volume
88
Issue
9
Pages
886–890
Identifiers
DOI: 10.1111/ans.14351
PMID: 29266719
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Simultaneous division of the splenic artery, splenic vein and pancreatic parenchyma during laparoscopic distal pancreatosplenectomy (LDPS) is known as the lasso technique, which is considered to be simple to perform. However, the original lasso technique carries a risk of post-operative bleeding from the splenic artery. We modified the original lasso technique to improve its technical safety and compared the perioperative outcomes of LDPS performed with the modified lasso technique (ml-LDPS) with those of conventional LDPS (c-LDPS). From August 2006 to July 2016, 30 patients underwent c-LDPS and 31 patients underwent ml-LDPS for distal pancreatectomy involving <50% of the pancreas. The perioperative outcomes of the two groups were compared. The ml-LDPS technique resulted in a shorter operation time (201 min versus 162 min, P < 0.01), less intraoperative blood loss (20 mL versus 200 mL, P < 0.01), a shorter post-operative hospital stay (8.0 days versus 12.5 days, P < 0.01), and a lower incidence of clinically relevant post-operative pancreatic fistulas (6.5% versus 26.7%, P = 0.04) compared with c-LDPS. The surgical approach (c-LDPS or ml-LDPS) was identified as an independent predictor of the development of clinically relevant post-operative pancreatic fistulas via multivariate analysis. The ml-LDPS method had beneficial effects on the operation time, intraoperative bleeding, the post-operative morbidity rate and the length of the post-operative hospital stay. The ml-LDPS procedure is a simple, safe and effective way of performing planned LDPS. © 2017 Royal Australasian College of Surgeons.

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