Pancreatic neck transection using a harmonic scalpel increases risk of biochemical leak but not postoperative pancreatic fistula after pancreaticoduodenectomy

Chien-Hui Wu; Ching-Hsuan Chen; Te-Wei Ho; Ming-Chieh Shih; Jin-Ming Wu; Ting-Chun Kuo; Ching-Yao Yang; Yu-Wen Tien

doi:10.1016/j.hpb.2020.07.002

Pancreatic neck transection using a harmonic scalpel increases risk of biochemical leak but not postoperative pancreatic fistula after pancreaticoduodenectomy

HPB (Oxford). 2021 Feb;23(2):301-308. doi: 10.1016/j.hpb.2020.07.002. Epub 2020 Sep 29.

Authors

Chien-Hui Wu¹, Ching-Hsuan Chen², Te-Wei Ho³, Ming-Chieh Shih⁴, Jin-Ming Wu³, Ting-Chun Kuo³, Ching-Yao Yang³, Yu-Wen Tien⁵

Affiliations

¹ Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Institute of Epidemiology and Preventive Medicine, Department of Public Health, National Taiwan University, Taipei, Taiwan.
² Institute of Epidemiology and Preventive Medicine, Department of Public Health, National Taiwan University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan.
³ Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
⁴ Institute of Epidemiology and Preventive Medicine, Department of Public Health, National Taiwan University, Taipei, Taiwan.
⁵ Division of General Surgery, Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: ywtien5106@ntu.edu.tw.

PMID: 32998842
DOI: 10.1016/j.hpb.2020.07.002

Abstract

Background: The effect of a harmonic scalpel on postoperative pancreatic fistula (POPF) has not been addressed. This study assessed the effect of pancreatic neck transection using a harmonic scalpel on rate and severity of POPF after pancreaticoduodenectomy (PD).

Methods: This retrospective analysis included patients who underwent PD at National Taiwan University Hospital between July 2015 and March 2019. We compared rate and severity of POPF between patients who underwent pancreatic neck transection using a harmonic scalpel versus electrosurgical unit.

Results: Of 422 consecutive PDs, the pancreatic neck was transected using a harmonic scalpel or electrosurgical unit in 144 and 278 patients, respectively. Use of a harmonic scalpel significantly increased risk of biochemical leak (25.7% versus [vs] 10.8%; P < 0.05) but not clinically relevant POPF (CR-POPF; 30.2% vs 26.4%; P = 0.41). Harmonic transection was an independent predictor of biochemical leak (odds ratio [OR] = 2.93; P < 0.05) but not CR-POPF (OR = 0.83; P = 0.41) or other major complications (OR = 0.72; P = 0.27). There was no significant intergroup difference in postoperative hospital stay.

Conclusion: Pancreatic neck transection using a harmonic scalpel increased risk of biochemical leak but not CR-POPF or other major complications.

MeSH terms

Humans
Pancreatectomy
Pancreatic Fistula* / etiology
Pancreaticoduodenectomy* / adverse effects
Postoperative Complications / etiology
Retrospective Studies
Risk Factors