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World J Gastroenterol. 2017 Feb 28;23(8):1507-1512. doi: 10.3748/wjg.v23.i8.1507.

Preventing pancreatic fistula after distal pancreatectomy: An invagination method.

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Nagato Katsura, Takahiko Hoashi, Seijun Fukuda, Kenji Shimizu, Department of Surgery, Misugikai Otokoyama Hospital, Otokoyama Izumi, Yawata, Kyoto 614-8366, Japan.


Following an increase in the use of the GIA stapler for treating a pancreatic stump, more techniques to prevent postoperative pancreatic juice leakage have been required. We describe one successful case using our new technique of invaginating the cut end of the pancreas into the stomach to prevent a pancreatic fistula (PF) from occurring. A 50-year-old woman with pancreatic cancer in the tail of the pancreas underwent distal pancreatectomy, causing a grade A PF. We resected the distal pancreas without additional reinforcement to invaginate the stump into the gastric posterior wall with single layer anastomosis using a 3-0 absorbable suture. The drain tubes were removed on the third postoperative day. Although a grade A PF was noted, the patient was discharged on foot on the eleventh postoperative day. Our technique may be a suitable method for patients with a pancreatic body and tail tumor.


Amylases; Neoplasms; Pancreatectomy; Pancreatic fistula; Pancreatic juice

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