A Novel Technique for Pancreatic Stump Closure: Clip Ligation of the Duct and Associated Suturing of Pancreas

Michail Papoulas; Elissaios Kontis; Olympia Hadjicosta; Nathaneal Pinsker; Nigel Heaton; Krishna V Menon

doi:10.7759/cureus.7414

A Novel Technique for Pancreatic Stump Closure: Clip Ligation of the Duct and Associated Suturing of Pancreas

Cureus. 2020 Mar 25;12(3):e7414. doi: 10.7759/cureus.7414.

Authors

Michail Papoulas¹, Elissaios Kontis¹, Olympia Hadjicosta², Nathaneal Pinsker¹, Nigel Heaton¹, Krishna V Menon¹

Affiliations

¹ Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, GBR.
² Medical School, Barts and the London School of Medicine and Dentistry, London, GBR.

Abstract

Pancreatic fistula (PF) remains the primary source of morbidity after distal pancreatectomy (DP). There is currently no optimal stump closure technique to reduce PF rates. We present a novel technique for pancreatic stump closure using Clip Ligation of the duct and Associated Suturing of Pancreas (CLASP). Five patients (three females) with a median age of 65 years underwent DP and splenectomy for pancreatic body or tail tumour using the CLASP technique. Four of those operations were done laparoscopically. Only one patient developed grade A PF. No other postoperative complications were noticed. The mean length of stay was 5.4 days. The CLASP technique was applicable in both laparoscopic and open distal pancreatectomy. The key points include mobilisation of the pancreatic body from the retroperitoneum and division of the parenchyma with energy device. The technique of pancreatic stump closure involves the isolation of the pancreatic duct (PD), application of a double ligaclip on the proximal duct, division of the PD and finally suturing of the pancreatic stump. The CLASP technique is an effective and safe alternative technique to the current traditional methods of pancreatic stump closure.

Keywords: distal pancreatectomy; laparoscopic; open; pancreas; stump closure; technique.