LigaSure for Pancreatic Sealing During Distal Pancreatectomy

Pancreatic fistula is an unresolved problem after distal pancreatectomy. The current study investigated the safety of LigaSure for distal pancreatic resection in a porcine model. A distal pancreatectomy was performed in 22 pigs. Animals were randomly assigned to undergo conventional scalpel transection with hand-sewn closure of the pancreatic remnant or pancreatic transection and sealing by LigaSure. Closed-suction drainage was collected daily. Animals were sacrificed on postoperative day (POD) 7 and the pancreatic remnant was sampled for histology. Two grade A postoperative temporary pancreatic fistulas (ISGPF definition) developed after hand suturing but none after LigaSure sealing. Amylase and lipase levels in drainage fluid were higher in the suture group during the first postoperative days but showed no differences after the fourth day. All but two animals that had to be euthanized because of small bowel invagination survived until POD 7. No significant differences were found in macroscopic changes between groups at reexploration. Histology demonstrated focal, chronic granulating inflammation with minor necrosis in all animals. The LigaSure sealing device provides a safe alternative to conventional hand-sewn closure of the pancreatic stump in distal pancreatectomy. This is the first study that investigated this effective and highly applicable technique for pancreatic transection.