Retrospective Analysis of the Effect of Hand-sewn and Stapler Closure of Pancreatic Stump After Distal Pancreatectomy on the Development of Postoperative Pancreatic Fistula

Abstract

Aim: Hand-sewn (HS) and stapled closure (ST) of pancreatic stump following distal pancreatectomy are two frequently used techniques. Rates of postoperative pancreatic fistula (POPF) might be associated with stump closure techniques. This study was carried out to determine rates of POPF after distal pancreatectomy and evaluate impact of two closure methods on development of POPF. 
 Material and Methods: All patients who underwent elective open or laparoscopic distal pancreatectomy for malignant and benign pancreatic pathologies between 2011 and 2021 were retrospectively evaluated. Patients were grouped as Groups HS and ST. POPF was diagnosed and graded according to International Study Group of Pancreatic Fistula guidelines. Rates of biochemical leak and grades of POPF were primary outcome. 
 Results: There were 44 patients (28 in Group HS and 16 in Group ST) with a mean age of 51.8±15.1 years. Groups were similar in demographic and clinical characteristics (p>0.05). There were 15 patients (53.6%) with a biochemical leak in Group HS. In Group ST, six patients (37.5%) developed biochemical leaks. There was no significant in difference between groups in terms of biochemical leak (p=0.305). No patient in Group ST developed a pancreatic fistula. There was only one case with Grade B POPF in Group HS. We did not detect a significant difference in terms of POPF between groups (p=0.999). 
 Conclusion: Both techniques had no significant impact on biochemical leak and POPF rates in patients who underwent distal pancreatectomy. Both pancreatic stump closure approaches are equally safe and can be used with similar clinical efficacy.