Clamp-crushing pancreas transection in pancreatoduodenectomy

Pancreatoduodenectomy is associated with high morbidity rates, resulting primarily from the occurrence of pancreatic fistula at pancreatojejunostomy. We transect the pancreas using a manual clamp-crushing technique to prevent postoperative pancreatic fistula (POPF) formation. The aim of this study was to clarify the usefulness of this new technique.

Fifty patients with a normal soft pancreas who underwent pancreatoduodenectomy in the last 3 years were selected. During the last stage of the classic Whipple operation, the pancreas was transected using a clamp-crushing technique under blood-flow control. The pancreas parenchyma was crushed using forceps, and small pancreatic branch ducts were securely ligated and cut. The main pancreatic duct was identified, and pancreatojejunal reconstruction was done end-to-side with a duct-to-mucosa anastomosis, following approximation of the pancreatic stump to the jejunal wall using the one-layer suture technique.

According to ISGPF (please use the first abbreviation for subtotal stomach--preserving pancreaticoduodenectomy) grading, POPF Grade B occurred in 10 (20%) patients. There were no Grade C patients, no postoperative hemorrhage and no POPF associated mortality.

The clamp-crushing technique appears to be a safe method for pancreatic transection that is feasible in cases with a normal soft pancreas.