Pancreatic transection using a reinforced staple to reduce pancreatic fistula rates following distal pancreatectomy

Abstract

Background: Distal pancreatectomy (DP) is frequently complicated by the development of postoperative pancreatic fistula (POPF). Various Methods to divide the pancreatic neck and reinforce the transected stump have been proposed, yet no single technique has been shown to be superior in the prevention of POPF. The aim of this study was to evaluate the rates of POPF following division of the pancreatic neck with the EndoGIATM stapler using a standard Tri-StapleTM reload compared to a reinforced Tri-StapleTM reload; utilising an integrated absorbable buttress material to reinforce the staple line. Conclusions: Patients undergoing elective DP under a single surgeon in the regional hepatobiliary centre were identified over a two-year period from October 2016 to October 2018. Between October 2016 and October 2017 transection of the pancreatic neck was performed using the standard Tri-StapleTM reload. From October 2017 to October 2018 division was completed using the reinforced Tri-StapleTM reload. Patient and operative details, mortality and morbidity were all collated. POPF was defined in accordance with the revised 2016 International Study Group of Pancreatic Fistula (ISGPF) guidelines. Results: 23 DP were performed over the two-year period; 12 using the standard Tri-StapleTM and 11 with the reinforced reload. The rate of POPF was lower in the reinforced stapler group, however this difference was not statistically significant (Table 1). In keeping with fewer and less severe grades of POPF, the mean length of stay (LOS) in the reinforced staple group was lower compared to the standard stapler (p=0.19). One mortality occurred in the standard stapler group in a patient who developed a Grade C POPF. Conclusion: Preliminary Results using a reinforced stapler are encouraging with a non-significant reduction in POPF in this small cohort; however larger scale, prospective studies are needed to confirm its efficacy in reducing the risk of this common and serious complication. Tabled 1Table 1.