Staple Line Reinforcement in Laparoscopic Distal Pancreatectomy Diminishes Hemorrhage and Pancreatic Duct Leakage

Esther C. Consten, MD, Michel Gagner, MD, FACS

Product Details
Product ID: ACS-2290
Year Produced: 2003
Length: 10 min.


Distal pancreatectomy, performed laparoscopically or open, is not without significant risk. Pancreatic duct leak and staple line bleeding can be particularly challenging problems to handle and represent a major source of morbidity in these patients (17-23%). As a result of this, modifications to stapling systems used for laparoscopic gastrointestinal surgery have been developed in an attempt to reduce these complications. One such modification is the addition of an absorbable polymer membrane to reinforce staple lines made with linear cutting stapling devices. The objective of this new technical step is to decrease hemorrhage at the staple line and to prevent pancreatic duct leakage. The patient is a 29 year old healthy man who presented for surgical evaluation after an episode of unconsciousness for 4 hours. Laboratory results showed hypocalcaemia and hypoglucosaemia. The patient had imaging with abdominal ultrasonography and CT scans, which were found to be unsuccessful in locating the lesion. The octreotide scan demonstrated an uptake in the tail of the pancreas. Endoscopic ultrasonography demonstrated a lesion in the junction of the body and tail of the pancreas which was compressing partly the pancreatic duct. Laparoscopic diagnostic ultrasonography was employed to determine the final operative strategy; a second insulinoma in the pancreatic tail was revealed. Subsequently, laparoscopic resection of the pancreatic tail was performed, preserving splenic vein and artery. In this procedure a novel staple line reinforcement technique was utilized and is shown in the video. He was discharged at the 3rd. postoperative day without leaks. Postoperative course remained uncomplicated. Pathology results demonstrated 2 insulinomas. Bioabsorbably staple line reinforcement material provides staple line reinforcement without requiring the implantation of a permanent prosthetic material. It diminishes perioperative bleeding and possibly pancreatic duct leaks. Concerns over possible long term complications such as migration, erosion, calcification and infection are reduced.