The Effect Of Wrapping The Pancreatic Stump With Omental On Preventing Pancreatic Fistula In Distal Pancreatectomy

Objective To undergo the distal pancreatectomy with animal experiment, the pancreas waswrapped by omental, and then the pancreatic stump was sutured during the operation andthe rates of postoperative pancreatic fistula were compared to explore a new simple andpractical method to effectively decrease pancreatic fistula.Methods50New Zealand rabbits were randomly divided into two groups:1. Controlgroup: The pancreas was merely sewn by5-0Prolene with U-type lock-stitch suture.2.Experimental group: The pancreas was looped with omental which would be sewn totightly attach to the pancreatic surface, and then the pancreas would be sutured by the samemethod as in control group. The distal pancreatectomy was carried out respectively in eachgroup. Peritoneal drainage fluid was collected with negative pressure suction system madeby negative pressure suction ball and mucous extractor. The amount of peritoneal drainagefluid was recorded and the amylase value was measured at the1st-7th day after surgery.The value of serum amylase、white blood cell（WBC）and C-reactive protein（CRP）weremeasured at the1st,3rd,5th and7th day after surgery. At the same time, the animalpostoperative mental condition, anorexia and other clinical symptoms were observed everyday. Abdominal B-ultrasound diagnosis was performed two weeks later, and then theanimals were euthanized followed by necropsy, the amylase value in seroperitoneum orbacterial culture would be further measured if there were abnormal fluid or abdominalabscess formation. The pathological examination of the pancreatic stumps were performedwhen the animals were euthanized.Results There were9cases of animal pancreatic fistula were occurred in Control group (25cases) and2cases were occurred in experimental group (24cases), and the pancreatic leakage rate in control group and experimental group were respectively36.0%(9/25) and8.3%（2/24）(P=0.020). In the experimental group, there was1animal death due to deepanesthesia, which was not included in the statistical analysis. The amount of intraperitonealdrainage was higher than the experimental group at the1st-7th day, but there were notstatistically significant (P1-7>0.05), the amylase values of peritoneal drainage fluid in thecontrol group was higher than the experimental group at the3th、6th postoperative day, andthere were statistical differences between two groups（P3=0.041，P6=0.026）, Blood levelsof amylase in the control group was higher than the experimental group, but the differencewas not statistically significant（P>0.05）; The value of CRP at the3rd day in the controlgroup was significantly higher than the experimental group after surgery, the differencewas statistically significant（P3=0.002）; the postoperative values of serum WBC was notstatistically significant in two groups, but the data in the control group showed anincreased first and then decreased trend while the experimental group showed a steadydownward trend. The operative time in experimental group and control group was61.2min±10.9min and53.2min±10.8min, the operative time of experimental group was slightlylonger. The postoperative clinical symptoms were no difference between the two groups.Pathological examination revealed a thick and dense "hat" structure composed of fibroustissue was formed in the edge of the pancreatic stump.Conclusions The anti-incising capability of pancreatic tissue could be significantlyenhanced by wrapping the pancreas with omental, and the complications of abdominalinfection, pseudocyst or abscess were not found associated with omental in experimentalgroup. Pathological examination revealed a thick and dense "hat" structure which wascomposed of fibrous tissue in the edge of the pancreatic stump, and this special structuremight play an important role in preventing the pancreatic fistula. Therefore, the incidenceof postoperative pancreas fistula was effectively decreased by wrapping the pancreaticstump with omental in distal pancreatectomy.