Abstract
Background
To date, no stump closure technique has been shown to be superior in lowering the risk of postoperative pancreatic fistula (POPF) after pancreatectomy. The aims our study were to investigate the possibility to influence POPF risk by selection of stump closure technique according to pancreatic parenchyma thickness and to establish a thickness cut-off value for selection of a hand-sewn and stapled closure technique.
Methods
A retrospective analysis of consecutive patients who underwent distal pancreatectomy at a single centre was performed. Anatomical determination of the transection site (pancreatic neck, body, or tail) was based on operative report and postoperative follow-up computed tomography (CT), with the thickness measured on the most recent CT image before surgery. Patients were classified by the thickness of the transection site, and sub-classified according to stump closure technique. POPF incidence, morbidity, mortality, and baseline-characteristics were investigated between groups.
Results
Among the 115 cases included in the analysis, the incidence of POPF was 33%, with no difference between stapled (29.9%) and hand-sewn (37.5%) closure techniques (p=0.426), regardless of transection site thickness. Among those with a transection site <13 mm, the incidence of POPF was 4.6% in the stapler subgroup versus 45.5% in the hand-sewn subgroup (p=0.0002). Among patients with a transection site ≥13 mm, the incidence of POPF was 75% in the stapler subgroup versus 30.8% in the hand-sewn subgroup (p=0.007).
Conclusions
Transection in the pancreatic neck, stapler closure of thin parenchyma, and hand-sewn closure of thick parenchyma were associated with significantly lower risk of POPF.
The rate of postoperative pancreatic fistula after distal pancreatectomy is independent of the pancreatic stump closure technique – A retrospective analysis of 284 cases
