Different Stapler Cartridge For Pancreatic Stump Texture To Prevent Pancreatic Fistula

Study Overview
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Brief Summary
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The purpose of this trial is to establish an objective criterion for assessing pancreatic stump texture, and unify stapler cartridge according to pancreatic stump texture and thickness.

Detailed Description
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Distal pancreatectomy (DP) is the standard treatment for symptomatic benign, premalignant, and malignant lesions in the pancreatic body and tail.Laparoscopic distal pancreatectomy (LDP) are reported to have lower blood loss, fewer postoperative complications and a shorter length of stay without a substantial increase in the operative time. Pancreatic fistula (PF) is the major source of postoperative morbidity and is associated with numerous further complications, suffering, longer hospital stay, higher costs and sometimes death. Frequencies range from 5% to 64%. Several procedures have been proposed to reduce the rate of PF. stapler closure is considered to be safe and approved particularly in LDP. Numerous predictive factors for PF have been reported in previous studies. Among these risk factors, the most important might be the texture and thickness of the remnant pancreas. However, the judgment of pancreatic texture has been based on the surgeon's observation and there still exists no objective method of assessing pancreatic texture. Furthermore there is no strict guideline on which type of cartridge to use according to pancreatic stump texture and thickness. Therefore, this single blind randomized controlled trial is designed to establish an objective criterion for assessing pancreatic stump texture, and unify stapler cartridge according to pancreatic stump texture and thickness. Patients were stratified intraoperatively by gland texture-hard (fibrotic) or soft (normal) and subsequently randomized according to different stapler cartridge. Pancreatic fibrosis is accessed by histopathology and pancreatic stellate cell.

Official Title
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A Randomized Trail Of Different Stapler Cartridge For Pancreatic Stump Texture To Prevent Pancreatic Fistula After Laparoscopic Distal Pancreatectomy

Conditions
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Pancreatic Neoplasms, Pancreatic Fistula

Intervention / Treatment
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* Procedure: traditional reloads
* Procedure: Tri-Staple reloads


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: disease of pancreatic body and tail Age: 18 years or older distant metastases are not diagnosed preoperatively. Patients who can provide written informed consent Exclusion Criteria: Patients with severe organ disease such as cardiac disease,respiratory illness Patients with pancreaticojejunostomy,pancreatogastrostomy Patients with conversion to laparotomy Patients with pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Tri-Staple reloads<br>Tri-Staple reloads were used for pancreatic stump texture | Procedure: Tri-Staple reloads<br>* Purple cartridge with2.0-2.5-3.0mm varied-height staples was used for pancreatic stump<br>|
| Active Comparator: traditional reloads<br>the traditional reloads were used for pancreatic stump texture | Procedure: traditional reloads<br>* Blue cartridge with3.0mm height staple was used for pancreatic stump<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of pancreatic fistula grade A/ B/C defined by ISGPF classification | Pancreatic amylase concentration in any post operative drains. Fistula is diagnosed if pancreatic amylase > 3 times the upper normal limit of pancreatic amylase in plasma on post operative day 3 or later | Thirty days after operation | 
| Pancreatic fibrosis accessed by histopathology and pancreatic stellate cell |  | intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Morbidity |  | Thirty days after operation | 
| Mortality |  | Thirty days after operation | 
| Time to oral intake |  | Duration of hospital stay | 
| Postoperative hospital stay |  | Duration of hospital stay | 
| Readmission rate |  | Thirty days after operation |