SEGMENTAL OCCLUSION OF THE PANCREATIC DUCT WITH PROLAMINE TO PREVENT FISTULA FORMATION AFTER DISTAL PANCREATECTOMY

Objective The authors used prolamine (Ethibloc, Ethicon GmBH, Norderst edt, Germany) for segmental obstruction of the pancreatic duct to prev ent pancreatic fistula development after distal pancreatectomy combine d with total gastrectomy for gastric malignancies. Summary Background Data Although the initial clinical application of prolamine was pancre atic duct obstruction for patients with pancreatitis and undergoing pa ncreatic transplantation and pancreaticoduodenectomy for pancreatic ca ncer, there are no reports on prevention of pancreatic fistula formati on after distal pancreatectomy. Methods Prolamine (0.2 mL) was injecte d into the distal segment of the main duct in the remaining pancreata of 51 patients. Small pancreatic ducts on the cut surface, from which prolamine extravasates, were closed by ligation, the main duct was lig ated doubly, and the transected pancreatic margin was closed 15 minute s after phenylpropanolamine hydrochloride injection. Results No patien t developed a pancreatic fistula or the complication of arterial bleed ing due to prolonged infection. Conclusion Segmental obstruction of th e pancreatic duct with prolamine is useful for preventing pancreatic f istula development after distal pancreatectomy.