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Background: The use of stapling devices for distal pancreatectomy remains controversial, due to concerns about the development of postoperative pancreatic fistula (POPF) and hemorrhage., Methods: We report herein the usefulness of the Endo SGIA stapler (Tyco Healthcare, Norwalk, CT) for distal pancreatectomy by placing 2 triple-staggered rows, ie, 6 rows of staples in the pancreatic stump. The pancreas was divided together with both the splenic artery and vein with Endo SGIA in 7 consecutive hand-assisted laparoscopic distal pancreatectomies., Results: No patients developed clinically significant POPF or postoperative hemorrhage. None of the patients had complications that may have influenced the length of hospital stay., Conclusion: The 6-row Endo SGIA stapler allows quick and effective prevention of POPF after distal pancreatectomy.

Background: Although the clinical benefits of hand-assisted laparoscopic surgery have been shown in several procedures including colorectal resection, splenectomy and gastrectomy, efficacy and invasiveness in pancreatic surgery have not been well investigated. We assessed the clinical benefits and invasiveness of hand-assisted laparoscopic distal pancreatectomy (HALS-DP) in relation to the occurrence of post-operative systemic inflammatory response syndrome (SIRS)., Methods: Subjects comprised 8 patients underwent HALS-DP (with splenectomy, n = 7; without splenectomy, n = 1) for benign or low malignant pancreatic lesions between March 2004 and December 2005. Indications for HALS-DP consisted of mucinous cystadenoma (n = 4), endocrine tumors (n = 2), serous cystadenoma (n = 1) and pancreatic pseudocyst (n = 1). Controls comprised 9 patients who underwent conventional open distal pancreatectomy (Open-DP) for benign or low malignant lesions of the pancreas in the same period., Results: No significant differences were identified between HALS-DP and Open-DP in operation time. However, intra-operative blood loss, CRP on post-operative day (POD) 1 [5.5 mg/dl (1.8-8.1) vs. 9.7 mg/dl (5.9-12.1); p = .006] and POD 3 [8.5 mg/dl (1.7-11.1) vs. 17.7 mg/dl (10.7-21.5); p = .003], occurrence of post-operative SIRS (13% vs. 67%; p < .05, one-sided), duration of SIRS [0 day (0-1) vs. 1 day (0-4); p = .02] and post-operative hospital stay were significantly lower in HALS-DP than in Open-DP. Furthermore, no pancreatic fistula was seen with HALS-DP, as compared to 2 (22%) with Open-DP., Conclusion: HALS-DP is safer and less invasive than Open-DP for benign or low malignant pancreatic tumors.